Trauma

Occasionally, cases may present as diagnostic problems: (1) Did the patient fall because of an underlying disease or was the trauma primary? (2) Is the necrosis due to the trauma (contusion of the crests of superficial gyri) or to vascular disease (usually deep in the sulci)? Contused cerebral tissue with petechiae; blood clots from epidural, subdural and intracerebral hemorrhages; and organizing subdural membrane usually give little difficulty in diagnosis. One can recognize the relatively slow evolution of the outer membrane of a subdural hematoma (Fig. 3.4) compared with the almost-non-changing

Evolution of subdural hematoma

Normal day days days wk wks 1 mo mo mo mo Years

Normal day days days wk wks 1 mo mo mo mo Years

Fig. 3.4. Schematic evolution of a subdural hematoma of moderately large size. Note that most of the reaction is in the outer membrane. Trichrome (green staining dura and fibrous tissue and red staining hemorrhage in the original) and iron (blue staining hemosiderin in the original) stains. Note RBC in dilated sinusoids at 1 month.

Fig. 3.4. Schematic evolution of a subdural hematoma of moderately large size. Note that most of the reaction is in the outer membrane. Trichrome (green staining dura and fibrous tissue and red staining hemorrhage in the original) and iron (blue staining hemosiderin in the original) stains. Note RBC in dilated sinusoids at 1 month.

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