Background,Aims and Objectives:Abusive head trauma(AHT)is an unusually injurious form of traumatic brain injury with substantial mortality and long term neurological deficits that are both common and severe.However,th...Background,Aims and Objectives:Abusive head trauma(AHT)is an unusually injurious form of traumatic brain injury with substantial mortality and long term neurological deficits that are both common and severe.However,the pathogenesis of the severe brain damage in this setting is unclear.Secondary hypoxic ischemic brain injury is often suggested but does not account for the asymmetry sometimes noted in the acute setting and the apparent patency of cerebral vessels.Materials and Methods:We sought to examine the pathogenesis of AHT by examining autopsy brains of individuals who survived AHT for a period of years and then expired.Results:We found that such individuals had distinct arterial vascular territory damage,often of brain regions supplied by the anterior circulation.There was also more damage superiorly in the cerebral hemispheres compared to inferiorly,marked asymmetry in some cases,variable hippocampal sclerosis,and in some cases,extreme cerebral destruction with relative preservation of the brainstem.Conclusions:In aggregate,our findings suggest that global hypoxic ischemic encephalopathy does not adequately explain the findings and that arterial vasospasm may underlie the devastating morbidity and mortality of AHT.展开更多
文摘Background,Aims and Objectives:Abusive head trauma(AHT)is an unusually injurious form of traumatic brain injury with substantial mortality and long term neurological deficits that are both common and severe.However,the pathogenesis of the severe brain damage in this setting is unclear.Secondary hypoxic ischemic brain injury is often suggested but does not account for the asymmetry sometimes noted in the acute setting and the apparent patency of cerebral vessels.Materials and Methods:We sought to examine the pathogenesis of AHT by examining autopsy brains of individuals who survived AHT for a period of years and then expired.Results:We found that such individuals had distinct arterial vascular territory damage,often of brain regions supplied by the anterior circulation.There was also more damage superiorly in the cerebral hemispheres compared to inferiorly,marked asymmetry in some cases,variable hippocampal sclerosis,and in some cases,extreme cerebral destruction with relative preservation of the brainstem.Conclusions:In aggregate,our findings suggest that global hypoxic ischemic encephalopathy does not adequately explain the findings and that arterial vasospasm may underlie the devastating morbidity and mortality of AHT.
