17166              CEREBRAL TRAUMA

The patient was a male pedestrian aged 58 struck by a car.  He was admitted to hospital unconscious.  Operation was carried out one hour after admission and an acute subdural haematoma was evacuated.  Tracheostomy was necessary on the following day.  He remained unconscious and died on the 6th day.  At postmortem there were compound fractures of the right tibia and fibula, spiral fracture of the left femur and fractures of both pubic rami.

The specimen is of the brain divided in the horizontal plane.  There is a large area of acute cortical laceration of the orbital surface of the anterior end of the right frontal pole.  There is a large area of acute cortical laceration of the orbital surface of the anterior end of the right frontal pole.  There is a thick layer of acute overlying subarachnoid haematoma.  There is less extensive cortical bruising of the left frontal lobe.  There is also cortical laceration with some overlying subarachnoid bleeding of the tip of the left temporal lobe.  There is very marked swelling of the right hemisphere and marked notching and transtentorial herniation of the right uncus and hippocampus with marked lateral compression of the midbrain.  The reverse of the specimen shows the right frontal laceration and contusion.  There is compression of the lumen of the right lateral ventricle and the septum pellucidum is deviated markedly to the left.  There are some acute concussive petechiae in the splenium of the corpus callosum.