Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

Abstract

Introduction: Microscopic study of the organization of the Subdural Haemorrhage (SDH) verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature.

Aim: This study was conducted for dating the early subdural haemorrhage by routine histopathological stains.

Materials and methods: A prospective analytical study was conducted during July 2009 to December 2010. A total of 100 cases (50 males and 50 females) fulfilling the inclusion and exclusion criteria were included in this study. Routine histopathological staining of the subdural haematoma was done.

Results: Correlation between the frequency of a given histomorphological phenomenon and the length of the Post-Traumatic Interval (PTI) was evidential. All the histomorphological features, when correlated with PTI groups, were found to be statistically significant, except for Polymorphonuclear Leukocytes (PMN).

Conclusion: We concluded that routine histopathology was reliable in the dating of early subdural haemorrhages.

Keywords: Medico-legal; Polymorphonuclear leuckocytes; Post-traumatic interval; Subdural haematoma.

[Table/Fig-1a-j]:

(a) Classification of all the cases according to survival time, (b) Frequency of detection of red blood cells, (c) PMN, (d) Macrophages, (e) RBCs in Macrophages, (f) Hemosiderin containing macrophages, (g) Fibroblast, (h) Collagenous fibers, (i) Early membrane formation, (j) Endothelial proliferation in the subdural hemorrhage about post-traumatic interval (hours).

[Table/Fig-7a-g]:

(a) Photomicrographs of acute SDH of <24 hrs duration is showing fresh hemorrhage with intact red blood cells. There is acute hemorrhage with alarge number of neutrophils seen on the dural side. (H&E x200) (H&E-hematoxylin and eosin). (b) Acute SDH (24-48hrs)-There is acute hemorrhage with fibrin infiltration. Many neutrophils (4+grade) and a few macrophages are seen (PAS, x400) (PAS-Periodic acid-Schiff) (c) Photomicrograph of SDH (4 days old) showing hemophagocytosis (Masson’s trichrome x1000) (d) Photomicrograph of SDH (4 days old) showing hemophagocytosis (PAS x1000) (PAS-Periodic acid-Schiff). (e) Photomicrograph showing hemosiderin-laden macrophages in the SDH-6 day old. (Prussian blue-reaction x400) (f) Photomicrograph showing SDH (6 days old) having a 3-5 cells thick layer of fibroblastsat the dural-clot interface. (H&E, x400) (H&E-hematoxylin and eosin). (g) Photomicrograph showing SDH 8 days old. Infiltration of the collagen into the hematoma can be observed (Masson’s trichrome, x200).