Distinction Between Cerebral Apoplexy and PostPost-traumatic Intracerebral Hemorrhage:

a)

b)

c)

In traumatic intracerebral hemorrhage the interval between the injury and onset of stroke is usually a week or less. In traumatic intracerebral hemorrhage, the injury to the head must be sustained when the head is in motion and the hemorrhage is the result of the coup-countre-coup mechanism. The location of traumatic intracerebral hemorrhage is in the central white matter of the frontal or temporo-occipital region. Cerebral apoplexy is usually at the basal ganglia, a very uncommon site of traumatic intracerebral hemorrhage.

d)

History of hypertension prior to the stroke and evidence of degenerative disease are present.

BRAIN:
A.

Laceration of the Brain 1. Direct or Coup Laceration 2. Countre-coup Laceration

HistoHisto-pathological changes following contusion and laceration of the cerebral Cortex:

Within 3 hours y 6-12 hours y 12-24 hours y 1-2 weeks y 1 month

y

Edemas of the Brain:

Localized Edema Generalized Edema

Concussion of the Brain:

Is a transitory period of unconsciousness resulting from a blow on the head, unrelated to any injury to the brain which is apparent to the unaided eye. Symptoms vary upon the degree of injury. In cases of recovery, there is usually a retrograde amnesia of the accident and even events before and after it.

Compression of the Brain

Face:
A.

Eye Contusion of the soft tissue about the eyes is subconjunctival. Hemmorhage is frequently observed in a first blow. Fracture of the base of the anterior cranial fossa may also produce contusion of the eyelids. Eye may be lacerated by a blunt weapon or by a piece of stone. Penetrating wounds due to sharp instruments or bullets may cause meningitis or total blindness.

B.

Nose x Fracture of the nasal bone is a common sequelae of first blows, and may cause severe epistaxis and facial deformity. x Injuries of the nose are usually dangerous to life on account of the extension of infection to the brain.

C.

Ear x A blow on the ear may produce a rupture of the tympanic membrane leading to permanent or temporary deafness. x Hemorrhage coming from the ear may suggest fracture of the base of the middle cranial fossa. x The trauma in the ear may cause septic infection amd may extend to the brain and causes death.

D.

Mouth x Contusion, laceration and swelling of the lips are usually observed in a first blow, kick or bite. x Fracture of the lower jaw is usually due to direct violence. x Occasionally a gun shot wound in suicidal case is found inside the mouth and investigators are usually at loss in the examination and location of the wound of entrance.

Neck

Abrasions of the neck may be present in cases of manual strangulation. Ligature marks are present in death by hanging. Suicidal cut-throat wounds are usually diagonal while homicidal wounds are usually horizontal. Asphyxia, pneumonia, hemorrhage and shock are the common causes of death from neck injuries.

Vertebral Column and Spinal Cord:

a.

Fracture of the vertebrae x Injury of the cord due to fracture of the upper four cervical vertebrae causes paralysis of the phrenic nerve, while those due to fractures of the 5th cervical vertebra to the first dorsal vertebrae may cause paralysis of all the extremities. The causes of the fracture of the spine may be: 1. Direct Violence 2. Indirect Violence

b.

Concussion of the Spine x May occur even without visible signs of external injuries. x The usual complaints are headache, restlessness, pain and tenderness over the spine, loss of sexual power, irritability of the bladder, inability to walk, weakness of the limbs, and derangement of the special senses.