TIMING OF EARLY CHANGES IN BRAIN TRAUMA

One hundred and fourteen fatal cases of brain trauma were examined pro spectively; in 100 of these cases, death occurred within 48 hours of i njury. The methods of injury included motor vehicle accidents (MVA), g unshot wounds, blunt instrument injuries, and falls. All cases showed subarachnoid and parenchymal hemorrhages. Paraffin sections were studi ed with hematoxylin and eosin (H&E) stain and also with special stains in selected slides. The cases were examined histologically before hav ing exact clinical knowledge of the time of death. Eosinophilic neuron s were noted in many cases surviving <1 hour after injury and increase d in frequency and severity with time. These were most commonly seen i n areas of contusion, the hippocampus, and the arterial boundary zones of the cerebral cortex. Neuronal incrustation was seen from 3 to 48 h ours postinjury in areas of contusion. Axonal swelling and spheroids w ere seen in the white matter in areas of laceration and hemorrhage at 1 hour postinjury in many cases and continuing through all time period s. Glial swelling was seen in the subpial and subependymal regions and around hemorrhages from very early to 48 hours postinjury. Polymorpho nuclear leukocytes (granulocytes) were present in the tissues at all t ime periods with increasing frequency over time. They were also found surrounding corpora amylacea in cases with <1 hour survival. Axonal sw elling, eosinophilia of neurons, and incrustation of neurons were note d at earlier time periods than previously reported in the literature. Determining the time of injury based on histologic evidence is difficu lt. We believe that the data reported here will allow more accurate ap preciation of timing of the early interval between brain trauma and de ath.