craniocerebral injuries types and examples.pptx

brief description of craniocerebral injuries

1. Autopsy analysis of craniocerebral injuries at a tertiary healthcare centre. By Dr. Aditya suman By bandu Waman Ramteke, shibanand Nepal Karmakar, Nilesh Keshav tumram 1.Department of forensic medicine, government medical college, Chandrapur, Maharashtra 2. Department of forensic medicine, Terna medical college,Nerul, Navi Mumbai, Maharashtra

2. Abstract Brain is one of the most vital organ in the body, despite it being protected by bony skull.craniocerebral injury or head injury is defined as “morbid state resulting from gross or subtle structural changes in scalp, skull and / or the contents of the skull produced by mechanical forces” A prospective study by department of forensic medicine at Indira Gandhi medical college and hospital Nagpur for 2 years. During study a total of 2048 cases of Medico Legal autopsy were evaluated for which 202 cases of death due to craniocerebral injuries.

3. Introduction Brain regulates vital functions, initiates and coordinates motor activities, receives sensory impulses ,emotions and intellectual activities . Brain is protected against mechanical stresses by bony skull Injuries to brain have increased due to mechanisation in industries, high velocity transport vehicles,increased use of alcohol in modern life. The total incident rate of traumatic brain injuries were 235 cases/100000 people per year with an average mortality of 15/100000 people per year and thus accounted for the majority of trauma deaths.

4. Materials and methods A descriptive cross-sectional study was conducted in the department of forensic medicine at Indira Gandhi government medical college and hospital Nagpur, for a period of two years. A total of 2048 cases of medico legal autopsy were evaluated. Out of total medicolegal autopsy cases , a total of 202 cases of death due to craniocerebral injuries were studied . current study was obtained from the police person nel investigating the cases. Age, gender, place of death, period of survival, circumstances of death, internal injuries to head and various structures of head were studied .

5. All the details of the cases were studied in detail in relation to various age groups . various external injuries . various internal injuries . cases with alchohol consumptions.

6. Out of 202 cases of craniocerebral injury 139 had isolated craniocerebral injury 63 cases had associated other injuries Total 202 cases Cases Died on spot Died after getting treatment Male 175 108 67 Female 27 20 7 Total cases 202 cases Died in Winter season Died in Rainy season Died in Summer season 93 24 85 Male 174 83 19 73 Female 27 10 5 12

7. Total 202 cases 06 am to 12 noon 12 noon to 06 pm 6 pm to 12 midnight 12 midnight to 06 am Death 40 42 51 31 Total 202 cases Accidentally Homocide Suicide Died 180 20 2 Total cases 202 12 to 2 days 2 days to 4 days More than 4 days 128+56 1 17

8. Total Accidental Homocide Suicide Male 175 156 17 2 Female 27 24 3 Total Blunt(non penetrating) Sharp(penetrating) 202 196 6 Pedestrian Four wheeler Fall Two wheeler Assault 55 35 33 27 20

9. Victims driving cycle contributed 12 cases Victims driving four wheelers 6 cases. Passengers of two wheelers 2. A total of 137 cases were due to road traffic accident caused by pedestrians, cyclist, drivers of four wheelers and two wheelers. Out of 137 cases of RTA. 78 cases of collisio n with moving motor/railway vehicle. 29 cases were of collision with pedestrian Less common common cases were of collision with non-motor vehicle 12. Loss of control on road 9, Non-collision, six cases and collision with stationary motor/railway vehicle 3 cases.

10. Circumstances of death Male Female Total Fall 29 04 33 Driver, passenger (4-wheeler) 06,29 _,06 41 Driver, pillion (Motorcycle) 27,01 _,01 29 Cyclist 12 _ 12 Pedestrian 47 08 55 Assault 17 03 20 Others 07 05 12 Distribution of cases as per circumstances of death

11. Distribution of cases as per circumstances of road traffic accident Circumstances of traffic accident Males Female Total Collision with moving motor/ railway vehicles 68 10 78 Collision with stationary motor/railway vehicle 03 __ 03 Collision with non-motor vehicle 12 — 12 Collision with pedestrian 26 03 20 Loss of control on road 09 __ 09 Non-collision accidents 05 01 06

12. Discussion Majority cases had isolated, craniocerebral injuries. This was in accordance with freytag E, sevitt S and maloney et al. This could be due to the fact that cases of even trivial injuries to the head Can lead to significant damage to structures of the head and hence cause death due to it. Majority cases were males. The high proportion of cases being males may be due to the fact that males are the main members of family, earning and working in Indian societies.

13. Most of the cases of craniocerebral cerebral injuries died on spot. It can be said that the cerebral injuries may cause immediate death of victims. About 70% of population in India is dependent on agriculture as their mean of earning. Hence, most of the population is busy in agriculture activities and hence prevalence of accident is less in rainy season. Extreme weather affects the prevalence of road accidents. Temperatures are very high in May, June in central India. People become more irritable, get tired and lose their concentration and their reaction time gets slower due to such high temperatures. This could be the reason why there are increased road accident in summers Accidents were comparatively less common during time period of 12 midnight to 6 AM. This might be due to fact that most of the people are at their homes and don’t go out during the period.

14. Majority of craniocerebral injury (97%) cases were due to blunt force. This was due to the fact as most of the cases were of road accident

15. In the present study, fracture of parietal bone and fracture of frontal bone was commonly found as compare to other cranial bones Fracture site Total cases Associated intracranial injury Frontal bone 32 30 Parietal Bone 35 34 Temporal bone 04 04 Anterior cranial fossa 17 17 Middle cranial fossa 47 47 Posterior cranial fossa 19 19 Occiput 04 04 Orbital roof 03 03 Sphenoid 02 02 Distribution of cases as per site of skull fracture and associated intracranial injury

16. In study of Kumar et al from 5092 cases of road traffic accident found Parietal bone fracture :-3% Frontal bone fracture:-9.4% Temporal bone fracture:-8.2% Occipital bone fracture:-3.6% Middle cranial fossa bones were commonly fractured compared to other cranial fossa bones in our study. Anterior + middle cranial fossa in 13.2% cases. Middle plus posterior renal fossa was found in 6.3% cases. Fracture of orbital bones in 1.6% cases.

17. Subdural, haematoma and subarachnoid haemorrhage were the most common intracranial injuries in the present study Intracranial injuries Cases Extradural hematoma 15 Subdural hematoma 112 Subarachnoid hemorrhage 99 Cerebral laceration 16 Cerebral contusion 12 Both cerebral laceration and cerebral contusion 12 Cerebellar laceration and /or contusion 06

18. Alcohol is an important contributing factor in fatalities due to road traffic accidents and hence in fatal head injuries. Distribution of cases with alcohol consumption. Profile of deceased Cases Four wheeler driver 03 Motor cycle driver 11 Assault 04 Total 18 62% deceased of road traffic accident had blood alcohol level in excess of permissible level.

19. Conclusion Injuries to head and brain are most commonly due to road traffic accidents and most commonly injured in them are pedestrians. craniocerebral injuries are most commonly during extreme temperature seasons compared to rainy seasons. Majority of craniocerebral injuries cause instantaneous death. Subdural and subarachnoid haemorrhages are more common than extradural hematomas . Fracture of cranial bones and intracranial bleeds increases the mortality in craniocerebral injury cases. Consumption of alcohol is a common causation for road traffic accident and subsequent craniocerebral injuries.