Craniocerebral Trauma and Vertebrospinal Trauma

Abstract

Trauma to the head and vertebral column results in focal or diffuse injuries affecting the skull and brain (``craniocerebral injuries'') or the vertebrae and spinal cord (``vertebrospinal injuries''). Focal injuries include: fractures; hematomas on either side of the dura (epidural hematomas and subdural hematomas); bleeding in the subarachnoid space; hematomas in the brain or spinal cord; bleeding in the cerebral ventricles; tears and fragmentation of central nervous system tissue (contusions and lacerations); and infarcts. Diffuse traumatic injuries include: brain swelling; diffuse or traumatic axonal injury; hypoxic-ischemic encephalopathy; widespread vascular injury. In many cases several different types of craniocerebral and vertebrospinal injuries coexist and their pattern may indicate the type of trauma that resulted in the injury. Craniocerebral and vertebrospinal injuries cause distinctive ``syndromes'' that may allow the pathologist to predict the type of neurological damage that will be encountered before an autopsy starts. These syndromes include patients who conform to the following states: ``dead at the scene;'' display a lucid interval between injury and death; coma from the time of injury; vegetative state; severe disability; moderate disability; minor disabilities; complete recovery after an injury; isolated quadriplegia or paraplegia.