W. Ezzat et al., PONTOMEDULLARY RENT - A SPECIFIC TYPE OF PRIMARY BRAIN-STEM TRAUMATICINJURY, The American journal of forensic medicine and pathology, 16(4), 1995, pp. 336-339
Pontomedullary rent is a primary injury to the brainstem that may occu
r in high-speed accidents. We present a series of 13 autopsies with co
mplete or partial pontomedullary rent documented over a 12-year period
. Of the 13 cases, seven had associated basal skull fractures and thre
e had fractures of the cervical spine. In five patients, the rent was
an isolated traumatic lesion of the brain. While pontomedullary rents
are mostly caused by traumatic craniocervical hyperextension, some aut
hors feel that these rents could be a form of diffuse axonal injury ca
used by angular acceleration of the head. In this study, two patients
had documented features of diffuse axonal injury. More than one mechan
ism of injury could therefore be involved. Pontomedullary rents could
be underdiagnosed, as partial rent is compatible with survival and, wh
en there are no associated fractures, these tears may be attributed to
artifactual damage occurring during removal of the brain at autopsy.