PubMed · 8374183
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L Rammer. 1993. Pathological definition.. https://doi.org/10.1111/j.1651-2227.1993.tb12866.x
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Subdural hematomas (SDH) are a frequent autopsy finding in victims of closed head injuries. About 2/3 of the cases in our own massive SDH series had brain contusions as a cause of bleeding. In about 1/3 of the cases, SDH resulted from ruptured vessels of the brain surface in the absence of contusions. Our experience has shown that such an "isolated" SDH may be expected in about 5% of fatal blunt head injuries. A technique is presented to detect bridging vein leakage before there is any risk of artificial damage. After sawing through the skull in the fronto-occipital plane and cutting through the upper half of the brain together with the calvarium, approximately 5-10 ml of barium sulfate are instilled into the superior sagittal sinus by a balloon catheter at low pressure, and X-rays are taken. If there is extravasation, the rupture is visible before further preparation.
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We have reviewed the reports from 222 autopsies performed during one year (1994) at our Department of Pathology. The majority (74%) of all autopsies were performed on patients from the Department of Internal medicine at our hospital. Autopsy findings were correlated with the clinically suspected causes of death, as revealed by the death certificates and the clinical information in the written requests for autopsies. The direct cause of death, as found at autopsy, had been suspected by the clinicians in 70% of cases. The underlying cause of death, as found by the pathologists at autopsy, had been diagnosed by the clinicians in 75% of the cases. In 26 cases (12%) the underlying cause of death had neither been diagnosed nor suspected by the clinicians. In the last mentioned group, 77% of the patients were more than 70 years of age. In six cases where the underlying cause of death had not been diagnosed or suspected by the clinicians, the findings at autopsy were classified as type-1 findings. These are findings, if they had been known when the patient was still alive would probably have led to therapy that night have improved the prognosis.