Case report of sudden death after a gunshot wound to the C2 vertebral bone without direct spinal cord injury: Histopathological analysis of spinal-medullary junction (original) (raw)
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Upper cervical spinal cord gunshot injury without bone destruction
International Journal of Surgery Case Reports, 2014
Second to mechanical traumas, gunshot or other penetrating instruments are the most common causes of spinal cord injury. Gunshot wounds of especially the upper cervical region are usually fatal. A case of bullet lodged intra-durally in the upper cervical region without damaging the vertebrae or the spinal cord is presented and discussed in the light of the literature. Introduction:
Journal of Forensic Sciences, 2010
Ricochet of a bullet in the spinal canal is well known by neurosurgeons but relatively not a common event in usual medico-legal autopsy practice. This article presents a homicide case of a penetrating gunshot injury of the lumbar spine through the T12-L1 intervertebral foramen with active movement of the projectile within the spinal canal to the L5-S1 level. This case illustrates a bullet intradural and intramedullary active movement because of a ricochet of the body of T12 with active redirection of the path. In the current literature, different types of migration in caudal or cranial direction, intradural, or intramedullary are reported. If spontaneous migration of T10 to S1 seems to be more frequent, some authors reported a C1 to S2 migration. Such migration could be asymptomatic or induce neurological impairment. The medico-legal consequences of these migrations within the spinal canal are described.
Routine techniques in forensic neuropathology as demonstrated by gunshot injury to the head
Legal Medicine, 2009
It will be vital to the practical activity of every forensic and/or clinical pathologist to be able to answer three questions regarding the reconstruction of a lethal event: the type and cause of death, as well as the survival time. The authors offer an overview of the application of selected morphological techniques in general forensic neuropathology, techniques that provide answers to some of the main questions in forensic neurotraumatology. The methods are illustrated by individual cases of lethal gunshot injury to the head from low velocity handguns.
Traumatic axonal injury, a clinical-pathological correlation
Journal of Forensic and Legal Medicine, 2017
Traumatic axonal injury (TAI) is a distinct clinico-pathological entity that can cause serious impairment of the brain function and can sometimes be found as a concrete cause of death. It has been discussed from the perspective of its biomechanical importance, and also from the standpoint of certain criteria for the pathological diagnosis of TAI. However, since the time when DAI (diffuse axonal injury) was initially described, there have been few, if any, discussions about the clinical-pathological correlation in TAI. This paper is an attempt to address this issue. For the purpose of certain pathological diagnoses of TAI, 63 cases with closed head injuries have been subjected to the complete forensic-neuropathological examination, involving immunohistochemistry with antibody against β-APP. In the diagnosis of TAI strict criteria have been followed. Then, retrograde analysis of the clinical parameters has been performed in order to determine some clinical-pathological correlation. The following two most reliable parameters of the impairment of the brain function have been analyzed: the impairment of the consciousness and the time of survival. Comparing the two groups, the one with TAI and the other without TAI, and using appropriate statistical evaluation, our results show that TAI is not a significant contributing factor to the lethal outcome in the early post injury period (24 hours), but it is undoubtedly a contributing factor for the severe impairment of the brain function indicated through the status of the consciousness.
The Distribution of Tissue Damage in the Spinal Cord Is Influenced by the Contusion Velocity
Spine, 2008
Study Design. A rat model of thoracic spinal cord contusion was used to examine the effect of velocity on the primary injury. Objectives. The overall objective of this study was to determine the effect of the contusion velocity (slow vs. fast) on damage to the spinal cord immediately following mechanical injury. Secondary objectives were to demarcate between damage in the gray and white matters and to observe damage to the mechanical elements of the neurons (i.e., neurofilaments). Summary of Background Data. Although studies have explored the effect of impact velocity on spinal cord damage and functional deficits, no study has addressed regional tissue damage of the primary injury (e.g., between the gray and white matter) as a function of velocity. Methods. A modified Spinal Cord Injury Research System generated 1 mm contusions in 24 male, Sprague-Dawley rats (210-320 g) at T10, using slow (3 mm/s) and fast (300 mm/s) velocities. The primary lesion (Ͻ2 minutes postinjury) was assessed using hematoxylin and eosin staining for hemorrhage volume and immunostaining for nonphosphorylated heavy neurofilament damage. Results. The volume of hemorrhage in the white matter was significantly increased following fast impact (fast ϭ 0.61 mm 3 , slow ϭ 0.24 mm 3 , P ϭ 0.013) whereas the total hemorrhage volume (fast ϭ 1.51 mm 3 , slow ϭ 1.21 mm 3 , P ϭ 0.22) showed no effect. Complete axonal disruption was evident in the fast injury group around the injury epicenter. A significant increase in nonphosphorylated neurofilament staining (P ϭ 0.013) was observed for fast impacts. Hemorrhage in the gray matter was similar between the slow and fast groups, but an increase in neurofilament dephosphorylation was observed in the gray matter following fast contusion (P ϭ 0.03). Conclusion. We conclude that contusion velocity has an effect on the magnitude of injury within the white matter during spinal cord injury and the amount of neur-onal damage in the gray matter. The results of this study demonstrate the importance of including high impact velocity as a variable in models of spinal cord injury.
C-Spine injury associated with gunshot wounds to the head: Retrospective study and literature review
The American Journal of Emergency Medicine, 2001
To determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head. Methods: A retrospective chart review including patients with GSWs to the head and excluding those with penetrating facial/neck trauma was performed. Cervical clearance was by clinical/radiologic criteria in survivors, and autopsy in nonsurvivors. A MEDLINE literature search was performed and relevant articles reviewed. Results: One hundred seventy-four charts were available for review; 90 had C-spine radiographs (complete series [49], lateral [33], and computed tomographic scan [8]). Of 84 with no radiographs, 29 were clinically cleared, and 55 died (32 cleared at autopsy). Twenty-three died without evaluation. None of the remaining 151 (87%) had CSI. Literature search yielded only three relevant articles. Combining the data from these articles yielded 534 patients, and CSI was excluded in 507 (95%). Conclusion: C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.
Spinal Gunshot Wounds: Pattern and Associated Lesions in Civilians
Asian spine journal, 2018
Retrospective, descriptive case series study. To investigate the frequency, bone pattern, and associated lesions to the spine of gunshot wounds. Gunshot wounds are penetrating in nature and are caused by a bullet or projectile. These are becoming more common and are associated with significant sequelae, requiring long and costly multidisciplinary treatment. Associated spinal cord injuries (SCIs) in the civilian population represent 13%-17% of all spinal traumas. Spinal gunshot wounds are commonly thought to be stable; however, there is potential acute and chronic spinal instability if the bullet passes transversely, fracturing either both pedicles or both facet joints. We obtained data from the clinical files of patients with spinal gunshot wounds treated by spine surgeons. We performed a statistical analysis to obtain the pattern and frequency of the injuries. We included 54 patients (48 men [89%] and six women [11%]). Eight patterns of spinal gunshot wounds were identified; 61% (3...