Hypoglycaemia is a cause of axonal injury

Axonal injury as demonstrated immunohistochemically is increasingly being r ecognized at post-mortem in patients who have been unconscious, and in some cases the cause of the coma may not be immediately apparent. Consideration s include microscopical diffuse traumatic axonal injury and axonal injury a ssociated with a range of metabolic encephalopathies. In this study, extens ive neurohistological examination was undertaken in 13 patients in whom com a was attributed to hypoglycaemia and in whom neurohistological examination had revealed varying degrees of widely distributed neuronal necrosis: in f ive of these cases there was also evidence that the intracranial pressure h ad been high with internal hernation. It is concluded that a significant am ount of axonal injury found in these 13 cases can be attributed to hypoglyc aemia per se although the amount and distribution of the axonal damage is a ltered in the presence of raised intracranial pressure. However, in some ca ses axonal damage is seen in the absence of an elevated intracranial pressu re and in one case its distribution closely mimicked that seen in microscop ical diffuse traumatic axonal injury. This further demonstrates that not al l axonal pathology is traumatic, and that adequate sampling and care in int erpretation of A beta-PP staining is required in forensic practice.