Histological changes in thalamus in short term survivors following traumatic brain injury: an autopsy study.
BACKGROUND
Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality. Reduction of thalamic volumes were seen in upto 80% of patients who survived for more than 3 months after TBI. However, the same may not be true in patients who died earlier following TBI.


OBJECTIVE
To to study the thalamus for evidence of any injury in short term survivors of TBI (<5 days) using immunohistochemistry to look for evidence of acute thalamic injury.


METHODS
A cross sectional prospective study was done in which autopsy specimens of short term survivors of TBI (<5 days) were studied for histopathological changes.


RESULTS
A total of 16 patients with a mean age of 37.8 years were included in the study. CT scan revealed acute subdural haematoma in 10, contusions in 4 patients, extradural haematoma and depressed fracture in 1 each, and diffuse axonal injury in 1 patient. Seven patients required surgery in the form of a decompressive hemicraniectomy. The histopathological analysis of the bilateral thalami showed evidence of congestion of the cerebral capillaries in 8 patients. Axonal retraction balls were seen in 8 patients, myelin breakdown products were seen in 14 patients and axonal swelling was seen in 14 patients.


CONCLUSIONS
Thalamic injury is universal in the setting of severe TBI in patients who have decreased survival and may be a significant factor for the poor outcome in these patients.
Ajay
A
Bisht
Kanwaljeet
K
Garg
Deepak
D
Agarwal
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Pankaj Kumar
PK
Singh
Guru Dutt
GD
Satyarthee
Deepak
D
Gupta
Sumit
S
Sinha
Aanchal
A
Kakkar
Vaishali
V
Suri
Sanjeev
S
Lalwani
Shashank Sarad
SS
Kale
Bhawani Shankar
BS
Sharma
D000328:Adult; D001344:Autopsy; D001930:Brain Injuries / Q000401:mortality* / Q000473:pathology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D017741:Survivors; D013788:Thalamus / Q000473:pathology*; D013997:Time Factors; D055815:Young Adult