Neuropathology Immediate and early effects Open head injuries

In open head injuries there is penetration of the skull often with considerable destruction of brain tissue local to the trauma, but relatively less at a distance—particularly for lower-velocity injuries such as stabbing. Open head injuries may therefore be associated with little, if any, loss of consciousness, which is generally a marker of diffuse brain injury.

In closed head injuries acceleration/deceleration forces and shearing forces damage the brain. The soft brain moves within its hard bony box and is damaged. Contusion of the brain occurs, ranging from slight localized small vessel bleeding into surrounding tissue to almost complete local destruction of the brain.

The medial orbital frontal cortex and the tips and undersurface of the temporal lobes are particularly vulnerable to contusions ( Fig 1). The brain becomes traumatized on adjacent bone of the floor of the skull. Contrecoup localization of contusions is sometimes evident.

Fig. 1 A composite of the contusions found in 50 cases of people dying from head injury. (Reproduced with permission from C.B. Courville (1937). Pathology of the central nervous system, Part IV. Pacific Press, Mountain View, CA.)

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