PRIMARY FOCAL IMPACT DAMAGE TO THE BRAINSTEM IN BLUNT HEAD INJURIES DOES IT EXIST ?

Serial blocks of brainstem from 100 fatal, blunt (non-missile) head injuries have been examined histologically. In 7 of the 18 patients in whom intracranial pressure had not increased there were constant abnormalities in the brainstem which could be attributed only to primary-impact injury—namely, lesions in, or adjacent to, one or both superior cerebellar peduncles and degeneration of axons in ascending and descending tracts in the brainstem. In all these 7 patients there was also damage elsewhere in the brain. It is suggested that so-called " primary brainstem injury " does not exist in isolation but is only an aspect of diffuse brain damage.