The Study of the Characters of Traumatic Brain Injuries (TBI) in Blunt Head Trauma Caused by Velocity-Related Injuries
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Abstract
Objectives: To determine the characters of traumatic brain injuries (TBI) related to the occurrence of coup-contrecoup phenomenon in blunt head trauma from velocity-related injuries
Methods: The prospective case control study was conducted in Thai postmortem cases sent for autopsies at the Department of Forensic Medicine, Siriraj Hospital, Mahidol University between 11th February 2021 and 31st December 2021. Subjects recruited had the age of 18 years old or over and were dead from traffic accident or falling from height. Data including sex, age, height and weight, configurations of skull, sites of scalp contusion, skull and skull base fracture, brain weight, epidural and subdural hemorrhage, coup-contrecoup contusion and macroscopic spot hemorrhage in white matter were recorded. The comparison of the characters of TBI between the presence and the absence of coup-contrecoup phenomenon was analyzed using descriptive statistics, independent sample t-test, Mann-Whitney U test and contingency table Chi-square test.
Results: There were 60 subjects recruited in this study (30 subjects with coup-contrecoup contusion and 30 subjects without coup-contrecoup contusion). The mean age and body mass index (BMI) between these two groups were not significantly different. The configurations of skull were also not significantly different for both temporal and occipital impacts. Brain weight in coup-contrecoup group was significantly greater than that in no coup-contrecoup group (1366.33 ± 84.42 g vs 1275.33 ± 105.63 g, p=0.001). Skull fracture with simple pattern, base of skull fracture without sella turcica involvement and subdural hemorrhage were significantly associated with the presence of coup-contrecoup contusion (p=0.027, p<0.001 and p=0.002, respectively).
Conclusion: Brain with coup-contrecoup contusion had significantly higher brain weight than brain without coup-contrecoup contusion. The presence of coup-contrecoup contusion was influenced by the characters of skull and base of skull fracture and the presence of subdural hemorrhage.
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References
Siripituphum D, Songwathana P, Khupantavee N, Williams I. Caring for Thai Traumatic Brain Injury Survivors in a Transitional Period: What Are the Barriers? J Health Sci Med Res 2020;38:43-52.
World Health Organization (WHO). Global status report on road safety [internet]. 2018 [cited 2021 December 7]. Available from https://www.who.int/publications/i/item/9789241565684.
Graham DI, Adams JH, Nicoll JA, Maxwell WL, Gennarelli TA. The nature, distribution and causes of traumatic brain injury. Brain Pathol 1995;5(4):397-406.
Davceva N, Janevska V, Ilievski B, Petrushevska G, Popeska Z. The occurrence of acute subdural haematoma and diffuse axonal injury as two typical acceleration injuries. J Forensic Leg Med 2012;19(8):480-4.
Kleiven S. Why most traumatic brain injuries are not caused by linear acceleration but skull fractures are. Front Bioeng Biotechnol 2013;1:15.
Drew LB, Drew WE. The contrecoup-coup phenomenon: a new understanding of the mechanism of closed head injury. Neurocrit Care 2004;1(3):385-90.
Gennarelli TA. Head injury in man and experimental animals: clinical aspects. Acta Neurochir Suppl (Wien) 1983;32:1-13.
Yoganandan N, Li J, Zhang J, Pintar FA, Gennarelli TA. Influence of angular acceleration-deceleration pulse shapes on regional brain strains. J Biomech 2008;41(10):2253-62.
Cepeda S, Gómez PA, Castaño-Leon AM, Munarriz PM, Paredes I, Lagares A. Contrecoup Traumatic Intracerebral Hemorrhage: A Geometric Study of the Impact Site and Association with Hemorrhagic Progression. J Neurotrauma 2016;33(11):1034-46.
Ratnaike TE, Hastie H, Gregson B, Mitchell P. The geometry of brain contusion: relationship between site of contusion and direction of injury. Br J Neurosurg 2011;25(3):410-3.
Martin G. Traumatic brain injury: The first 15 milliseconds. Brain Inj 2016;30(13-14):1517-24.
Ren L, Wang D, Liu X, Yu H, Jiang C, Hu Y. Influence of Skull Fracture on Traumatic Brain Injury Risk Induced by Blunt Impact. Int J Environ Res Public Health 2020;17(7):2392.
Barbosa A, Fernandes FAO, Alves de Sousa RJ, Ptak M, Wilhelm J. Computational Modeling of Skull Bone Structures and Simulation of Skull Fractures Using the YEAHM Head Model. Biology (Basel) 2020;9(9):267.
Pearce CW, Young PG. On the pressure response in the brain due to short duration blunt impacts. PLoS One 2014;9(12):e114292. doi: 10.1371/journal.pone.0114292.
Yoganandan N, Pintar FA, Sances A Jr, Walsh PR, Ewing CL, Thomas DJ, et al. Biomechanics of skull fracture. J Neurotrauma 1995;12(4):659-68.
Yavuz MS, Asirdizer M, Cetin G, Günay Balci Y, Altinkok M. The correlation between skull fractures and intracranial lesions due to traffic accidents. Am J Forensic Med Pathol 2003;24(4):339-45.
Kawamata T, Mori T, Sato S, Katayama Y. Tissue hyperosmolality and brain edema in cerebral contusion. Neurosurg Focus 2007;22(5):E5. doi: 10.3171/foc.2007.22.5.6.
Jha RM, Kochanek PM, Simard JM. Pathophysiology and treatment of cerebral edema in traumatic brain injury. Neuropharmacology 2019;145(Pt B):230-46.
Evaggelakos CI, Alexandri M, Tsellou M, Dona A, Spiliopoulou CA, Papadodima SA. Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study. J Forensic Leg Med 2022;85:102283. doi: 10.1016/j.jflm.2021.102283.