An 87-year-old woman suffered a right frontal TBI when she accidentally fell into a nursing home.
The medical history included mitral valve disease, episodes of paroxysmal atrial flutter and hemodynamic angina, and deep vein thrombosis with pulmonary thromboembolism.
She was under drug treatment with Sintrom®, Acuprel®, Nitroplast®, Trangorex® and Diluton®.
As a result of TBI, a blunt wound occurs in the right ciliary region and is repaired by suture.
The next day, in a period of less than twelve hours, after starting his usual emergency activities, he suffers a progressive deterioration of consciousness and anisocoria with a right pupil in the mid-hysteria by hospital.
On admission Glasgow 8-9 and anisocoria were outstanding.
Cranial computed tomography (without contrast) was performed, which was reported as "chronic rebleeding SDH" covering the right frontal, temporal and parietal regions; right supracallosal and transtentorial herniation (RAH); and subarachnoid hemorrhage.
After neurosurgical evaluation, it was decided not to intervene and remove her residence again, dying 14 hours later.
1.
In the diligence of lifting the corpse we find the body of a woman who represents the mentioned age.
Many patients with sickle cell disease have different stages of evolution.
Due to its relationship with the facts, the presence of a wound sutured with four points in the right ciliary region together with multiple cysts with different colors (red and blue) close to it stands out.
Judicial autopsy is performed within thirty-one hours of death.
In the internal habit, the abdominal level, there are several macroscopic findings of interest.
The heart weighs 250 g and presents calcified atheroma plaques in the anterior descending and circumflex coronary arteries that reduce > 90% light, calcification of the left papillary muscle and mitral posterior wall annulus.
The right frontotemporal-parietal SDH consists of dark clotted blood without evidence of associated fractures.
The encephalon is fixed in formaldehyde for 24 days before completing its macroscopic study, observing the following findings: weight 1018 g and in addition to the described SDH, there is external mesenteric hemorrhage in the right subarachnoid space.
In coronal sections, we observed right hemisphere enlargement, especially of the frontal lobe, associated with subdural hematoma of 15 mm and gelatinous aspect, with no evidence of left frontal lobe and left frontal hemorrhage, right frontal lobe dilatation to the left ventricle.
Mesencephalon shows extensive midline hemorrhage, right paramedian portion and dorsolateral quadrants and, in the protuberance, foci of hemorrhage are recognized in the soil of the IV ventriclebellum and peduncle.
1.
Samples of subdural hematoma, bark and white matter were taken from the right frontal parasagittal region, lenticular nucleus, internal capsule, thalamus, corpus callosum, hippocampus, mesencephalic analysis.
The microscopic study of the subdural hematoma shows that it is composed of well conserved substances in the periphery and acellular proteinaceous material in the central zones.
We did not appreciate and did not observe signs of infection (perseveral negative staining) or organization on the side of the arachnoids (the duramater was adhered to the non-microscopic signs of study).
Given the diagnostic disparity between CT and autopsy when at the time of SDH, preparations corresponding to the hematoma are re-examined and identified in some areas around the hematoma.
1.
In the cerebral parenchyma adjacent to the hematoma, glial cells with early recurrences ( globoid morphology with eosinophilic cytoplasm) are identified and around the described foci of hemorrhage, edema is observed.
Occasional axonal balls and spongiosis around the hemorrhages are observed in the trunk.
1.
Other neuropathological findings compatible with the patient's age were the presence of numerous senile plaques throughout the cortex, microcalcifications in basal ganglia and hippocampus, and neurons with degeneration.
The chemical-toxicological analysis performed at the INTCF (Second informed consent form) in a blood sample was negative for the toxics investigated (such as alcohol, non-steroidal anti-inflammatory drugs, morphine-based agents, tramadol antihypertensives).
Thus, we consider that the sequence of the lesions or pathology found would be the following: elderly person with a history of heart disease referred above, in treatment with oral anticoagulants (Sintrom®), suffers a right frontoparietal ruptured cyst and intracranial hypertension causing a mild head injury.
