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Biomechanical Aspects

Mechanically induced SAH results when the strain produced by angular acceleration is sufficient to damage the superficial vessels in the subarachnoid space. Ommaya and Gennarelli (1974) theorized that lesion depth correlates with the intensity of impact, suggesting that SDH associated with SAH reflect relatively severe injury of the brain from high angular acceleration of long duration. Though each EDH and SDH may be accompanied by an SAH, an impact can also lead to an isolated SAH as seen in Fig. 7.23, the sequelae of a blow.

Ruptures of superficial vessels in the leptomen-inges, especially veins, are common in mechanical brain injury. Their occurrence is sometimes isolated, and sometimes in association with dural hematomas and/or cortical hemorrhages. The literature describes only a few cases of rupture of the intact large arteries at the base of the brain. The biomechanical factors in such cases are described by Ommaya and Gennarelli (1974).

Krauland (1982) has reviewed and analyzed a number of cases involving mechanically induced basal arterial rupture without preexisting vessel damage: in rare cases, rotation- and/or acceleration-induced changes in tissue pressure, tension or shearing forces in association with an increase in

Fig. 7.22a-d. Axonal injury indicating acceleration damage tein (ß-APP). a Central parts of the pons (magnification X100); b associated with SDH as demonstrated by means of immunohis- corpus callosum (magnification X1,000); c, d cervical spinal cord tochemistry using an antibody against ß-amyloid precursor pro- (magnification X1,000)

Fig. 7.22a-d. Axonal injury indicating acceleration damage tein (ß-APP). a Central parts of the pons (magnification X100); b associated with SDH as demonstrated by means of immunohis- corpus callosum (magnification X1,000); c, d cervical spinal cord tochemistry using an antibody against ß-amyloid precursor pro- (magnification X1,000)

Table 7.3. MRI changes of SDHs dependent on the survival times of the victims. Source: Mori 1991

Survival time

Biochemical and cytological composition

Signal intensity

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