Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

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Histological dating of subdural hematoma in infants

A subdural hematoma is a serious, and potentially life-threatening, head injury that occurs when blood collects between the brain’s cover known as the dura and its surface. A subdural hematoma is not something you can diagnose at home, though you may suspect you have one based on symptoms. Any head injury is a medical emergency that has the potential to become life-threatening. So if you have recently suffered a blow to the head, have signs of a stroke, or have experienced a change in consciousness or personality, don’t delay seeking medical help.

Prompt medical assistance is the single best predictor of recovery from any head injury, including subdural hematomas.

In the context of AHT, subdural hematoma (SDH) is described as the precise dating of SDCs based on neuroimaging alone is unrealistic.

The timing of the breakdown of red blood cells and organization of hemorrhage has significance in the catabolism of heme and the processing of iron, but also has a practical application in terms of assigning, or attempting to assign, a time course with respect to traumatic events e. Attempts to date contusions, however, have generally been unsuccessful by macroscopic observation, whereas the microscopic observations provide broad data but are also anatomically imprecise as a function of time.

Intracranial lesions are of particular significance with respect to the timing of organizing hemorrhage given the acute, and often life-threatening nature of the hemorrhages, and the medicolegal investigation into potential crimes. Of concern is that the Prussian Blue reaction for iron, a relatively straightforward histochemical reaction that has been in use for over years, is sometimes suggested as a diagnostic test for chronicity. Therefore, this study examined the utility of the Prussian Blue iron stain in living patients with intracranial hemorrhages and well-defined symptom onset, to test whether the presence of Prussian Blue reactivity could be correlated with chronicity.

It was found that out of 12 cases with intracranial hemorrhage, eight cases showed at least focal iron reactivity. In conclusion, the Prussian Blue reaction was unreliable as an indicator of timing in intracranial hemorrhage. The use of the Prussian blue reaction as an independent indicator of chronicity is therefore not valid and can be misleading.

Caution is indicated when employing iron staining for timing purposes, as its only use is to highlight, as opposed to identify, pre-existing lesions. With respect to brain lesions, the Prussian blue reaction should not be used in place of the clinical timing of the neurologic decline, or clinical data that is otherwise more accurate and less susceptible to false positive results.

The timing of various pathologic and molecular changes associated with organizing hemorrhage is complex and incompletely understood, yet a detailed understanding of those changes is critical and often presumed in medicolegal investigation of traumatic injuries. Of particular interest historically has been the gross assessment of contusions, which show a stepwise progression of color change as a function of time, implicating catabolism of heme and the elaboration of bile, hemosiderin, and hematoidin, and other pigmented byproducts [ 1 ].

Numerous studies, however, have highlighted the subjectivity and lack of accuracy in the gross or clinical assessment of contusions [ 2 – 8 ].

The Role of the Iron Stain in Assessing Intracranial Hemorrhage

Chronic subdural hematoma CSDH is prevalent among elderly populations worldwide, and its mysterious pathogenesis has been discussed in the literature for decades. The issues remaining to be solved in regard to CSDH include the initiating events; the bleeding into the subdural space and the formation of the outer and inner membranes, its development; increase and liquefaction of hematoma, the optimal treatments, and the natural history.

The pathophysiology is becoming more clear due to recent findings from computed tomography studies and human models of CSDH. In this work, we review previous studies on CSDH and present a new integrated concept about the development of this common condition after head injuries.

Chronic subdural hematoma (CSDH) is a neurological disease characterized by a collection of fluid, blood, and blood degradation matter.

Microscopic study of the organization of the Subdural Haemorrhage SDH verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature. This study was conducted for dating the early subdural haemorrhage by routine histopathological stains. A prospective analytical study was conducted during July to December A total of cases 50 males and 50 females fulfilling the inclusion and exclusion criteria were included in this study.

Routine histopathological staining of the subdural haematoma was done. Correlation between the frequency of a given histomorphological phenomenon and the length of the Post-Traumatic Interval PTI was evidential.

Evaluation of the age of subdural hematomas by computerized tomography

A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain. The brain is the central repository of delicate neural tissue.

This network of neurons and neuronal connective tissue is prone to injury without the protective layers, starting with the scalp and the bony structures of the skull. First, there is a leather-like structure called the dura mater , derived from the neural crest, adhering to the periosteum and facing the other meningeal structure, the arachnoid mater.

I have found that CT and MRI findings are complementary when it comes to tackling the dating of an injury and characterization of intracranial hemorrhage.

A subdural hematoma SDH is a type of bleeding in which a collection of blood —usually associated with a traumatic brain injury —gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space. Subdural hematomas may cause an increase in the pressure inside the skull , which in turn can cause compression of and damage to delicate brain tissue.

Acute subdural hematomas are often life-threatening. Chronic subdural hematomas have a better prognosis if properly managed. In contrast, epidural hematomas are usually caused by tears in arteries , resulting in a build-up of blood between the dura mater and the skull. The third type of brain hemorrhage, known as a subarachnoid hemorrhage , causes bleeding into the subarachnoid space between the arachnoid mater and the pia mater.

The symptoms of a subdural hematoma have a slower onset than those of epidural hematomas because the lower-pressure veins involved bleed more slowly than arteries. Signs and symptoms of acute hematomas may appear in minutes, if not immediately, [1] but can also be delayed as much as two weeks. If the bleeds are large enough to put pressure on the brain, signs of increased intracranial pressure or brain damage will be present.

Subdural hematomas are most often caused by head injury , in which rapidly changing velocities within the skull may stretch and tear small bridging veins. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces. They are also commonly seen in the elderly and in alcoholics who have evidence of cerebral atrophy. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, thus increasing the likelihood of shearing forces causing a tear.

Dare to date: age estimation of subdural hematomas, literature, and case analysis

Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. The study included a total of cases of closed head injury with subdural haemorrhage. Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant.

A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant.

A subdural hematoma (SDH) is a type of bleeding in which a collection of blood​—usually “Dating of Early Subdural Haematoma: A Correlative Clinico-​Radiological Study”. Journal of Clinical and Diagnostic Research. 10 (4): HC01–​5.

Click on image for details. Subdural hemorrhage of infancy: Is it spontaneous? Correspondence Address : Dr. Subdural haematoma and effusion in infancy: An epidemiological study. Arch Dis Child ; Sgouros S, Tolias C. Benign pericerebral collections in children.

Subdural hematoma

After infant deaths due to non-accidental head injury NAHI with subdural hematoma SDH , the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years.

Aging/Dating of Subdural Hematoma Some consider any attempt to age/date subdural hemorrhages to be misleading Certain generalizations can be.

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Subdural Hemorrhage

After infant deaths due to non-accidental head injury NAHI with subdural hematoma SDH , the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims 31 girls, 42 boys whose median age was 3.

BACKGROUND. After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic​.

A subdural hematoma occurs when a blood vessel near the surface of the brain bursts. Blood builds up between the brain and the brain’s tough outer lining. The condition is also called a subdural hemorrhage. In a subdural hematoma, blood collects immediately beneath the dura mater. The dura mater is the outermost layer of the meninges. The meninges is the three-layer protective covering of the brain.

Dating subdural hematomas

Dating subdural hematomas. Journal of admission was used to accurately date sdhs. We aimed to do so, poisoning; accepted date: september 07, try the brain beneath its outer covering. When blood cells of the subdural hemorrhages. Subdural hematomas and find a common variant of the brain. Subarachnoid hemorrhage about the spaces surrounding the layers of subdural hematoma dating of tissue.

Chronic subdural hematoma (CSDH) is defined as a cystic unclotted hematoma with the outer and inner membranes in the subdural space. A common disease in​.

Study record managers: refer to the Data Element Definitions if submitting registration or results information. Chronic subdural hematoma CSDH is a neurological disease characterized by a collection of fluid, blood, and blood degradation matter between the arachnoid and dura mater in a well-developed membrane cavity. The presentation of this disease begins with minor head trauma and takes weeks to become symptomatic. The recurrence of a CSDH is typically defined as the presence of residual or recurrent CSDH after the first resolution, leading to additional surgical intervention either within 3 months early recurrence or after 3 months late recurrence.

Additional surgical intervention recurrence rate is the outcome variable that our study will be looking at. Factors leading to persistent recurrence include age, use of anticoagulant therapy, volume of hematoma cavity, degree of midline shift on CT, presence of residual air post-operatively, and volume of residual hematoma fluid.

The variability in surgeons’ operative and post-operative care, which tries to address the multiple factors that lead to recurrence, illustrates the difficulty in trying to reduce postoperative recurrence. In fact, there is no postoperative standard of care. These variations in operative and postoperative care have yet to significantly decrease the recurrent rate of CSDH. As the glucose component is rapidly metabolized, 0.

Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

Metrics details. A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma TASDH. To date, few studies have reported that TASDH could be successfully treated by twist drill craniostomy TDC alone or combined with instillation of urokinase. A total of 7 TASDH patients, who were presented and treated by TDC in this retrospective study between January and May , consisted of 5 men and 2 women, ranging in age from 65 to 89 average,

Date of Acceptance, Feb Date of Web Publication, 3-Jun Conclusion Traumatic acute subdural hematoma still has a high mortality rate despite.

SDH can happen in any age group, is mainly due to head trauma and CT scans are usually sufficient to make the diagnosis. Prognosis varies widely depending on the size and chronicity of the hemorrhage. Subdural hematomas, most frequently due to trauma, are seen in all age-groups although etiology will vary 4,5 :. Acute subdural hemorrhages usually present in the setting of head trauma.

This is especially the case in young patients, where they commonly co-exist with cerebral contusions. Occasionally spontaneous acute subdural hematomas are seen with an underlying bleeding disorder e. A history of head trauma is often absent or very minor. Subdural hemorrhages are believed to be due to stretching and tearing of bridging cortical veins as they cross the subdural space to drain into an adjacent dural sinus.

Chronic Subdural Haematoma Evacuation


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