Autopsy findings in diffuse axonal injury statistical review

Context: Diffuse Axonal Injury is an important pathological substrate of Traumatic Brain Injury. Knowing the clinical, radiological and post-mortem features of diffuse axonal injury can significantly increase our understanding of this entity in particular and traumatic brain injury as a whole and may help us in treating as well as predicting the outcome of patients with diffuse axonal injury. Aim: To analyze the clinical, radiological and gross & histological autopsy features of Diffuse Axonal Injury in severe head injury patients. Settings and Design: Prospective Cross-sectional Study Methods and Materials: 32 patients admitted to the neurosurgical ward of the Institute of Neurosurgery, Madras Medical College & RGGGH, between the period of October 2012 to March 2015, with Severe Head injury (GCS<8) and CT scan brain suggestive of Diffuse Axonal Injury were included in the study. Demographic data was collected and radiologic features were analyzed. Patients who died during the course of treatment were included in the study and autopsy was done. Of the 90 patients who had DAI, 32 patients expired and were subjected to autopsy and findings were analyzed. Results: It was observed that SAH was the commonest gross autopsy finding (62.5%). Hypoxic Changes with cellular swelling were the common findings in microscopic examination. Microscopic Lesions in Thalamus were the most statistically significant post-mortem finding. Conclusions: Thus in our study we found that in most cases CT Brain findings did not correlate with severity of head injury. The study shows that edema in the brain stem and corpus callosum were the predisposing causes of death.