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- W2079522024 abstract "The neuropathological findings in 54 cases of prolonged coma and in various post-comatose transitory stages following closed head injury are reported. They were chosen from a series of 576 necropsies of closed cranio-cerebral injuries showing survival from some minutes up to 1 year. The cases with protracted coma (survival 12–301 days) are compared with a control series of patients showing long survival after short periods of initial coma. In cases of prolonged post-traumatic coma, the brains showed multifocal lesions of primary and secondary traumatic origin often associated with late sequelae of these alterations. Skull fractures, expanding intracranial haemorrhages and cortical contusions were less frequent than in acute fatal cases, whereas the results of mechanical lesions in the basal ganglia, callosum-fornix system and cerebral white matter were comparatively frequent. The morphological picture of this “protracted post-traumatic encephalopathy”, however, is dominated by secondary (reactive) lesions and their sequelae which preferentially account for the clinical course. In addition to severe and often diffuse degeneration of the cerebral white matter of primary and secondary traumatic origin, multiple lesions were recognized in the basal ganglia, corpus callosum, hippocampal gyri, and limbic system. The incidence and extent of these results of various post-traumatic circulatory and anoxic disorders exceeds those of the mechanical lesions. Whereas severe primary damage to the brain stem is not usually survived for longer than a few hours, the most frequent and most conspicuous findings in prolonged coma are secondary lesions of the upper brain stem. They were present in 83.0% of the reported series. They included focal necroses, haemorrhages and their sequelae as well as diffuse glial dystrophies. They are the mechanical and vascular sequelae of increased intracranial pressure and thus closely resemble brain stem lesions which occur in space-occupying processes of varying aetiology. These brain stem lesions show characteristic patterns of distribution which make for close clinical-morphological correlations. They often affect central parts of the rostral brain stem and basal diencephalon involving the rostral mesencephalic activating system. These lesions account for persistent impairment of alertness and conditions consistent with chronic functional decerebrate states. Comparing the clinical data and anatomical findings in the present series of cases showing late sequelae of closed head injury, evidence is presented that brain stem lesions predominantly account for the clinical features and the prognosis of these severe post-traumatic conditions. The associated multiple lesions of the cortex, cerebral white matter and other subcortical regions may merely modify the clinical picture. The pathogenesis, topographical pattern and physiological pathology of the rostral brain stem lesions in these forms of post-traumatic encephalopathy are discussed." @default.
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- W2079522024 title "Protracted post-traumatic encephalopathy" @default.
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- W2079522024 doi "https://doi.org/10.1016/0022-510x(70)90091-2" @default.
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