[Pure shearing injury--clinical signs and symptoms, diagnosis, prognosis and review of the literature].
In some of the brains of head injury, shearing of axons and vessels caused by direct impact is seen widely in the white matter. This type of injury is designated by neuropathologists as shear injury or diffuse damage of impact type. Macroscopic lesions adjacent to the superior cerebeller peduncle and lesions of the corpus callosum are commonly seen in the brains with severe shearing injuries and the former is detected by CT scan as a high density at the quadrigeminal cistern, and this indicates occurrence of a severe shearing injury. Among 600 patients with head injuries, we managed 23 cases with pure shearing injury. These cases are classified into three groups according to the duration of coma. In the fulminant type (7 cases) the patients had severe brainstem signs including impairment of vital signs and died immediately after the injury. In the severe type (8 cases) the patients were decerebrated with normal pupillary response on admission and were severely disabled (i.e. tremor, truncal ataxia, dementia). In the moderate type (8 cases), the patients had only disturbance of consciousness for a long period, and recovered almost to the pre-injury state. Follow-up CT scan showed enlargement of the ventricles and sulci.
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000473:pathology; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed