Evaluation of brain injuries in children deceased due to head trauma.

Traumatic brain injuries (TBIs) present an ever-growing prevalence, especially in the developing countries. Although 80-95% are mild to average injuries, they determine multiple severe neurological sequelae and disabilities. Most of these injuries are caused by traffic accidents. We studied a number of 29 cases of severe TBIs, in children who deceased immediately or after a few days of survival. Most of them (over 68%) were caused by traffic accidents. The incidence of traumas increased by age, most cases being recorded in the age group 10-15 years old. The TBIs were complex ones. In 86.21% of the cases, the forensic examination highlighted the presence of cranial fractures; in 93% of the cases, there were highlighted complex meningo-cerebral injuries: leptomeningeal hemorrhage associated with brain contusion injuries and with intraventricular blood flood, as well as destructive lesions of brain dilaceration; only in 7% of the cases there were highlighted meningeal lesions, with no brain lesions. The severity of the brain injuries was quite varied, according to the force of the cause agent. The histopathological and immunohistochemical examinations showed that the severity of TBIs increased according to the survival time, by adding secondary lesions caused by brain ischemia and local inflammatory reaction.

Clinico-statistical and morphological aspects of severe traumatic brain injuries.

Traumatic brain injuries (TBIs) represent a problem of public health all over the world if we consider its incidence, mortality and the big social costs. The increase of road and train traffic, the development of industry, the growth of alcohol consumption, the emergence and increase of terrorist attacks have led to more frequent and severe TBIs. There were registered 3260 deaths at the Institute of Forensic Medicine in Craiova, Romania, between 2010 and 2014; they were the result of severe traumas, 622 (19.07%) being caused by TBIs. The most affected by TBIs were men (the men÷women ratio was of 3÷1) and the elderly, mainly in the rural area. The main risk factor was alcohol intake; about 44% of the deceased people were under alcohol influence. The forensic examination highlighted the severity of cerebral meningeal lesions, the most frequent being cerebral and vascular lesions. The histopathological and immunohistochemical examinations emphasized various microscopic changes in accordance with the severity of the trauma and the time passed from impact until death.