[Primary injuries of corpus callosum vessels in craniocerebral injuries]. / Pervichnye povrezhdeniya sosudov mozolistogo tela pri cherepno-mozgovoi travme.

The aim of the scientific work is to establish morphological characteristics of hemorrhages in the corpus callosum as a marker of primary vascular injuries in diffuse axonal injury (DAI) in relation to the goals and objectives of forensic examination. Changes in the structures of corpus callosum were analyzed in 45 corpses of persons with traumatic brain injury who died in hospital from DAI diagnosed according to clinical and instrumental data within 24 hours after the trauma. The changes were characterized by rectic hemorrhages (haemorrhagia per rhexin) in combination with successively developing vascular, tissue, and cellular post-traumatic reactions. These changes were not observed in the control group. The following morphological characteristics of hemorrhages were established: small focal, elongated, clearly contoured hemorrhages of different sizes, up to 4 mm long, up to 0.8 mm wide, unidirectional at an angle from the lower to upper surface of the sagittal corpus callosum section, at least three, grouped in limited areas sized up to 1.5 × 1.0 cm without clear borders. The detected hemorrhages and the course of changes give reason to consider them the result of primary traumatic effects, making them a diagnostic marker of DAI.

[Morphological markers of pathophysiological changes in the neuronal processes in the acute post-traumatic period of diffuse axonal injury]. / Morfologicheskie markery patofiziologicheskikh izmenenii otrostkov neironov v ostrom posttravmaticheskom periode diffuznogo aksonal'nogo povrezhdeniya mozga.

The purpose of the study was to establish morphological markers of pathophysiological changes in the neuronal processes of in the acute (up to 36 hours) post-traumatic period of diffuse axonal injury (DAI) for the purposes of expert practice. Histological examination of the body of corpus callosum of the corpses of 66 persons dead from DAI and of 25 persons dead from various non-violent and violent causes, excluding head trauma, was performed (control group). Morphological markers of specific pathophysiological changes in the neuronal process were established by light microscopy with the use of immunohistochemical examination in acute period DAI. Uneven contours of the processes suggested displacement of cytoskeletal elements, areas of vacuolization of the cytoplasm of the processes suggested violation of intracellular transport caused by a change of permeability with preserved integrity of the process shell without mechanical separation of the process, uneven thickness (3.9 ± 1.6 µm) of the processes, varicose and cone-shaped thickening of them was a manifestation of focal edema of the neuronal process and compression of the cytoskeleton as a result of ion-enzymatic disorders, uneven coloration, areas of fragmentary compaction of neurofilaments indicated the zones of deformation and compression of the cytoskeleton, zones of granular-lumpy decay and fibrillolysis of neurofilaments indicated destruction of the cytoskeleton. Changes in the neuronal processes are a manifestation of a polyethological general pathological process and are not a differential diagnostic criterion of DAI.

[Expert errors in formulating a forensic diagnosis and conclusions in cases of diffuse axonal brain damage]. / Ekspertnye oshibki pri formulirovanii sudebno-meditsinskogo diagnoza i vyvodov v sluchayakh diffuznogo aksonal'nogo povrezhdeniya mozga.

The study objective is to review expert errors in the wording of a post-mortem diagnosis and expert conclusions in cases of traumatic brain injury with diffuse axonal brain damage. We reviewed 50 corpse examinations of those who died from a traumatic brain injury with diffuse axonal brain damage. A retrospective analysis of the results of expert examinations, the structure of the post-mortem forensic diagnosis, and the validity of expert conclusions showed that expert errors were made in 30% of cases. In 93% of cases, the errors were epistemological due to the lack of a scientifically based methodological approach to the expert opinion on a particular mechanism for the development of traumatic brain injury with diffuse axonal brain damage; and lack of professional expertise. A case is provided demonstrating the most common expert errors in the examination of this type of traumatic brain injury.

[The original method for corpus callosum autopsy study in the case of diffuse axonal brain injury]. / Original'nyi sposob sektsionnogo issledovaniya mozolistogo tela pri diffuznom aksonal'nom povrezhdenii golovnogo mozga.

The article offers an original method for human corpus callosum autopsy examination in the case of diffuse axonal injury (DAI) and a rational scheme for sampling its zones for microscopic examination, aimed at determining the morphological characteristics of injuries, taking into account their anatomical and topographic localization. The results of the comparative study prove the objectivity and high efficiency of the proposed approach to post-mortem diagnosis of DAI.

[Axotomy in the postmortem diagnosis of diffuse axonal brain injury]. / Aksotomiya v posmertnoi diagnostike diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

The results of the study of the significance of axotomy in the postmortem diagnosis of diffuse axonal brain damage are presented. In the corpus callosum, two main types of changes in the processes of neurons were found: damage to the processes without mechanical rupture and axotomy. The revealed polymorphism of damage to the processes of neurons indicates the heterogeneity and staging of pathological processes caused both by the trauma itself and by developing reactive post-traumatic changes. Severe damage to the processes is secondary and not earlier than 2 days after the injury lead to axotomy, the morphological manifestation of which is retraction balls with a diameter of 15.5±6.33 µm, detected by staining with hematoxylin and eosin. Research results indicate that axotomy should not be differentiated into primary and secondary.

[Postmortem diagnostic of diffuse axonal injury considering histoarchitectonic of the corpus callosum]. / Posmertnaya diagnostika diffuznogo aksonal'nogo povrezhdeniya s uchetom gistoarkhitektoniki mozolistogo tela.

The results of studying the morphological signs of diffuse axonal injury (DAI) postmortem diagnosis in the brain are presented. It was investigated the histoarchitectonics of the corpus callosum in various types of non-violent and violent death. In the indusium griseum of the corpus callosum, neurons were identified; the features of the morphology and the interposition of the neurons processes, glia and vessels in various parts of the corpus callosum were studied. Taking into account the revealed architectonics of the corpus callosum, changes in DAI were determined. It was found that the main diagnostically significant morphological sign of DAI is hemorrhages localized in the trunk and indusium griseum on sagittal corpus callosum sections, which may be important in solving expert questions about the morphogenesis of hemorrhages in the corpus callosum.