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Evidence for Cerebral Microvascular Injury in Head Trauma Involving Infants and Young Children

Journal of Forensic Science and Medicine 2022年第2期8卷 41-45页

作者： Rudolph J.Castellani ashley rose scholl Carl J.Schmidt Department of Pathology Northwestern University Feinberg School of MedicineChicagoIllinoisUSA Department of Pathology Duke University School of MedicineDurhamNorth CarolinaUSA Department of Pathology Wayne County Medical Examiner's OfficeDetroitMichiganUSA Department of Pathology University of MichiganAnn ArborMichiganUSA

Background:The pathophysiology of lethal head trauma in infants and young children involves repetitive rotational forces of sufficient magnitude to produce subdural hemorrhage and brain swelling,which leads to considerable morbidity and *** precise mechanism for brain swelling is *** and Methods:We examined cerebral tissue from ten pediatric deaths due to blunt force trauma,along with seven control infants who asphyxiated in unsafe sleep *** assess the competence of the blood-brain barrier,we performed immunohistochemical stains for albumin and immunoglobulin G(IgG).Results:IgG and albumin were increased in subpial and superficial perivascular tissue in those cases due to blunt force trauma,and in particular,the blunt force trauma associated with subdural *** included two deaths at the scene without hospital survival ***:Our findings suggest disruption of the blood-brain barrier with vasogenic edema as an early event in head trauma involving young children upstream of global ischemic brain *** hypothesize that mechanical injury to the cortical vasculature results in vasogenic edema by oncotic(increased plasma proteins in the cortical interstitium)and hydrostatic(increased capillary pressure)mechanisms,with subsequent cortical *** may explain why ischemic sequelae appear to occur in head trauma involving young children,regardless of whether anoxia,hypotension,or cardiac arrest complicate the disease course and may in part underlie the high morbidity and mortality of head trauma in early childhood.

关键词： Edema pediatric head trauma subdural hematoma traumatic brain injury

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