Ультраструктурная характеристика синусов твердой мозговой оболочки при судебно-медицинской оценке черепно-мозговой травмы

Abstract

Aim. Search for features of the ultrastructural structure of the dura mater sinus that can be used to clarify the forensic diagnosis of the immediate cause of death, if it occurred as a result of brain damage in traumatic brain injury, and was accompanied by thrombosis of the dura mater sinuses, including against the background of connective tissue dysplasia. Materials and methods. Retrospective analysis of medical documents, laboratory, instrumental, using atomic force microscopy and sectional study of individuals with clinically diagnosed craniocerebral trauma and sinus thrombosis of the dura mater against the background of connective tissue dysplasia. 144 cases of isolated traumatic brain injury, which were the main cause of death, were investigated, according to the Omsk regional Bureau of forensic medical examination for the period 2017-2020. Сorpses of persons who were treated for the period 2017-2020 in the Omsk city clinical hospital No. 1 and the Omsk city clinical ambulance No. 2. 54 cases in persons with signs of connective tissue dysplasia, 90 cases in persons without signs of connective tissue dysplasia, which made up the control group. Inclusion criterion: Isolated traumatic brain injury. Terms of providing medical care in a hospital setting from a few hours to 64 days. Dura mater sinus thrombosis detected in the section as a result of trauma. Exclusion criteria: pathology of the blood system, pathology of the nervous system, the presence of chronic intoxication of various origins (alcohol, drugs, drugs). Cases of gross neurological dysfunction. Traumatic brain injury that is not compatible with life. The main and control groups were identical in gender and age composition: 103 male and 31 female subjects, aged from 16 to 50 years. Results. In a sectional study of subjects with isolated traumatic brain injury, thrombosis of the dura mater sinuses in various types of traumatic brain injury was observed. More often in people with signs of connective tissue dysplasia. the peculiarity of the dura mater ultrastructure in these individuals was the cause of inadequate sinus lumen when changing the speed and direction of venous blood flow in the sinus. This caused the formation of secondary necrosis and the development of cerebral edema. A feature of the ultrastructural structure of the dura mater in individuals with connective tissue dysplasia was revealed – changes in the type and location of fibrils and collagen fibers in the intrasinus apparatus in subjects with connective tissue dysplasia. This probably leads to a decrease in the extensibility and elasticity of the walls of venous vessels and does not correspond to the parameters of venous outflow when the blood flow rate changes. This feature of the ultrastructure can be a criterion for clarifying the forensic diagnosis in cases of traumatic brain injury, if they were with a favorable prognosis. Conclusion. The peculiarity of the ultrastructural structure of the dura mater in individuals with connective tissue dysplasia was established. it creates an obstacle to maintaining an adequate sinus lumen when the intra-sinus pressure changes in the acute period of traumatic brain injury. This leads to a high incidence of sinus thrombosis of the dura mater, in a greater number of cases, in persons with signs of connective tissue dysplasia.