Beitrag zur Entstehung des traumatischen Hirninfarktes

Summary

Cerebral infarctions due to the occlusion of main branches of cerebral arteries, which are manifested after the affection of mild head injuries, are sometimes one of the most difficult problems in order to reconstruct an acculate causality between external events and pathomorphological changes. We have experienced four cases of the cerebral infarction (occlusion of middle cerebral artery) and brain softening, which were provoked after the affection of head injuries. As the preexisting vascular lesions following findings were obtained. One case was the typical thrombus formation on thearteriosclerotic arterial wall, which was injured by head blow. Two cases wereendarteriitis obliterans, which were aggreviated suddenly (intramural hemorrhage in one case and thrombus formation in another one after the affection of mechanical injuries. The last one was the softening of the brain tissue surrounding theintracerebral aneurysma, which was associated with the growth of brain tumor. Chronological examinations of these four cases including pathological changes of the brain tissues, findings of the damaged arteries and their preexisting diseases and also the clinical history of the patients (especially the clinical pathology) coincided exactly each other, so that the acculate causality was reconstructed in each case. The criteria of the reconstruction of the causality in such cases (triad: the accordance of chronological analysis of clinical history, damaged artery and brain tissue) are discussed.

Zusammenfassung

An 3 Fällen wird die traumatische und posttraumatische Entstehung von Hirnblutungen und -erweichungen mit den Kriterien der Untersuchung und Begutachtung erläutert. Wichtig war stets die Übereinstimmung zwischen dem Datum der Verletzung und dem geschätzten Alter der makroskopischen und mikroskopischen Veränderungen.