title: Focal traumatic brain stem injury is a rare type of head injury resulting from assault: a forensic neuropathological study.
abstract: BACKGROUND
  Brainstem haemorrhage is common in cases of head injury when it is associated with space-occupying lesion and increases in the intracranial pressure (duret haemorrhage), in cases of diffuse axonal injury (in dorso-lateral quadrant) and diffuses vascular injury (in the periventricular tissue). However focal traumatic brainstem injury is rare.
  
  
  METHODS
  We identified 12 cases of focal traumatic brainstem injury from review of 319 case of head injury. The head trauma had been caused by different mechanisms of complex fall from height and assault. 10/12 are associated with skull fracture, 11/12 with contre coup contusions in the frontal and temporal lobes, 5/12 direct contusions to cerebellum, 5/12 haemorrhage in corpus callosum and 2/11 have gliding contusions. None of the cases had pathological evidence of increase in the intracranial pressure. The bleeding in the pons was at the edge in 2/12 and cross the section in 10/12. The majority of patients were unconscious immediately after the incident (10/12) and 9/12 died within one day.
  
  
  CONCLUSIONS
  Focal traumatic brainstem injury occurs most likely due to direct impact at the back of the head or stretching forces affecting the brainstem in cases of complex fall from height and after assault, particularly those associated with kicks. It is a serious and commonly fatal brain damage, which needed to be differentiated from other causes of brainstem haemorrhages.
authors.affiliation: Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. safa.al-sarraj@nhs.net
authors.forename: Safa
authors.initials: S
authors.lastname: Al-Sarraj
authors.forename: Ashley
authors.initials: A
authors.lastname: Fegan-Earl
authors.forename: Antonia
authors.initials: A
authors.lastname: Ugbade
authors.forename: Istvan
authors.initials: I
authors.lastname: Bodi
authors.forename: Rob
authors.initials: R
authors.lastname: Chapman
authors.forename: Simon
authors.initials: S
authors.lastname: Poole
authors.forename: Ben
authors.initials: B
authors.lastname: Swift
authors.forename: Peter
authors.initials: P
authors.lastname: Jerreat
authors.forename: Nat
authors.initials: N
authors.lastname: Cary
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000369:Aged, 80 and over; D016564:Amyloid beta-Protein Precursor / Q000378:metabolism; D001369:Axons / Q000473:pathology; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D001929:Brain Edema / Q000473:pathology; D001930:Brain Injuries / Q000473:pathology; D001933:Brain Stem / Q000293:injuries* / Q000473:pathology*; D003593:Cytoplasm / Q000378:metabolism; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000166:cytology / Q000378:metabolism; D012887:Skull Fractures / Q000473:pathology; D014474:Unconsciousness / Q000209:etiology; D014754:Violence; D055815:Young Adult
chemical_list: D016564:Amyloid beta-Protein Precursor