Medicolegal Importance of Histological Examination in Cases of Mild Traumatic Brain Injury

Fawzy, Heba; Mohamed Diab, Noha Farid

doi:10.21608/ejh.2022.169739.1791

Medicolegal Importance of Histological Examination in Cases of Mild Traumatic Brain Injury

Document Type : Original Article

Authors

¹ Department of Histology and cell biology, Faculty of medicine, Ain shams University, Cairo, Egypt

² Department of forensic medicine and clinical toxicology, Faculty of medicine, Ain shams University, Cairo, Egypt

10.21608/ejh.2022.169739.1791

Abstract

Introduction: The management of traumatic brain injury is challenging as patients with apparent mild head trauma may develop late complications. Some patients may develop an intracranial hemorrhage several days after the injury. Hence, emergency doctors may be more liable to malpractice claims. Also, histological examination can reveal forensic evidence in cases of unclear death. Therefore, it is of great importance to highlight the medicolegal and histological aspects of traumatic brain injury(TBI).
Aim of the Work: To highlight the medicolegal and histological aspects of mild traumatic brain injury.
Materials and Methods: Thirty adult female albino rats were included.The animals were divided into three groups: Group I (Control group). Group II:it included10rats, they were sacrificed 6 hours after closed head impact model .Group III: It included 10 rats , which were sacrificed 7 days after closed head impact model. At the end of the experiment, the specimens were taken and processed for immunohistochemical and histological studies.
Results: Examination of frontal cerebrum sections after 6hours revealed dilated congested blood vessels of pia matter .The cerebrum showed dark shrunken neurons with swelling of neuroglia .Inflammatory cells and rod shaped microglia. The medulla showed widely separated nerve fibers. After 7 days, the cerebrum showed apparent decrease in neurons and inflammatory cells. This was confirmed by increase in GFAP reaction (gliosis).The medulla showed thinning of nerve fibers.
Conclusion: Histological examination can be used to seek forensic evidence for TBI in absence of gross findings. Even with apparent mild head injuries, significant microscopic cerebral changes may be found. So, some patients will require in-hospital observation and cannot be safely discharged. In patients who can go home, discharge instructions need to be clear and documented. Also, in unclear deaths, brain tissue blocks may reveal evidence of TBI.

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