Dilemmas surrounding the occurrence mechanism of cerebral diffuse vascular injury

Abstract

The multiple petechial hemorrhages in the white brain matter, i.e. the diffuse vascular injury is a kind of diffuse brain injury which occurrence mechanism hasn't been explained so far. In a purpose to enlighten some dilemmas surrounding this, in this paper 11 cases with diffuse vascular injury, that make 18% from a material of 60 closed head injury cases where forensic neuropathological examination was conducted, were analyzed regarding these several issues: the type of traumatic event; the survival time; the presence and the extent of the skull fractures; and particularly, the mutual correlation between the diffuse axonal injury, which is known to occur as a result of acceleration-deceleration rotational forces, and the diffuse vascular injury, whose mechanism of occurrence has hitherto not been established. Our results indicate that diffuse vascular injury is a fatal diffuse brain injury with a survival time of up to several hours (4 hours is longest time in our material) that occurs mainly in traffic accidents, but also in some cases of a fall from height. Most of them are accompanied by extensive damage to the bones of the skull, implying that this kind of injury occurs as a result of the direct impact of a high-intensity force on the head. There are differences between diffuse vascular injury and diffuse axonal injury regarding some of the analyzed issues which is why we believe that these are two distinct types of diffuse brain injury and not different degrees of manifestation of the same type of brain injury.