Timing of early changes in brain trauma

One hundred and fourteen fatal cases of brain trauma were examined prospectively; in 100 of these cases, death occurred within 48 hours of injury. The methods of injury included motor vehicle accidents (MVA), gunshot wounds, blunt instrument injuries, and falls. All cases showed subarachnoid and parenchymal hemorrhages. Paraffin sections were studied with hematoxylin and eosin (H&E) stain and also with special stains in selected slides. The cases were examined histologically before having exact clinical knowledge of the time of death. Eosinophilic neurons were noted in many cases surviving <1 hour after injury and increased in frequency and severity with time. These were most commonly seen in areas of contusion, the hippocampus, and the arterial boundary zones of the cerebral cortex. Neuronal incrustation was seen from 3 to 48 hours postinjury in areas of contusion. Axonal swelling and spheroids were seen in the white matter in areas of laceration and hemorrhage at 1 hour postinjury in many cases and continuing through all time periods. Glial swelling was seen in the subpial and subependymal regions and around hemorrhages from very early to 48 hours postinjury. Polymorphonuclear leukocytes (granulocytes) were present in the tissues at all time periods with increasing frequency over time. They were also found surrounding corpora amylacea in cases with <1 hour survival. Axonal swelling, eosinophilia of neurons, and incrustation of neurons were noted at earlier time periods than previously reported in the literature. Determining the time of injury based on histologic evidence is difficult. We believe that the data reported here will allow more accurate appreciation of timing of the early interval between brain trauma and death.