Regarding instantaneous cerebral swelling following severe cranio-cerebral trauma with brain evisceration.

Abstract

We have recently read the article ‘‘Is cerebral swelling following cranio-cerebral trauma instantaneous? An insight into the Byard and Vink proposition’’ by Kanchan et al. [1], regarding the rapidity of development of cerebral swelling in humans in cases of instantaneous death with brain evisceration due to sustained severe head blunt force injury. The mechanism proposed by Byard and Vink [2], for an almost immediate cerebral swelling in such cases, was reactive vasodilatation. Indeed, photos of such cases demonstrated obvious gyral flattening indicating cerebral swelling [1, 2]. Unfortunately, these findings were not demonstrated microscopically. One of our cases was a 69-year-old female, who committed suicide by jumping from a building about 40 m high onto a solid concrete surface and who died on impact. The deceased suffered severe blunt force head injury with evisceration of the cranial structures (Fig. 1a). The gyral flattening and slight swelling of the eviscerated brain tissue parts could be observed (Fig. 1b). Microscopic examination showed perivascular spongious changes (i.e. microscopic signs of edema) (Fig. 2), probably predominantly caused by vasogenic edema [3]. Such microscopic appearance could also be a postmortem artifact [4, 5]. In adults, intracranial pressure is normally 5–15 mmHg [6], i.e. up to 2 kPa [3], in various body positions. In newborns and children, intracranial pressure is even higher [7]. It means that the intracranial pressure is positive— higher than the atmospheric pressure.