Diffuse axonal injury is one of the most important types of brain damage that can occur as a result of non-missile head injury, and it may be very difficult to diagnose post mortem unless the pathologist knows precisely what he is looking for. Increasing experience with fatal non-missile head injury in man has allowed the identification of three grades of diffuse axonal injury. In grade 1 there is histological evidence of axonal injury in the white matter of the cerebral hemispheres, the corpus callosum, the brain stem and, less commonly, the cerebellum; in grade 2 there is also a focal lesion in the corpus callosum; and in grade 3 there is in addition a focal lesion in the dorsolateral quadrant or quadrants of the rostral brain stem. The focal lesions can often only be identified microscopically. Diffuse axonal injury was identified in 122 of a series of 434 fatal non-missile head injuries--10 grade 1, 29 grade 2 and 83 grade 3. In 24 of these cases the diagnosis could not have been made without microscopical examination, while in a further 31 microscopical examination was required to establish its severity.

SUMMARY A detailed neuropathological examination has been undertaken on a consecutive series of head injuries dying in the Institute of Neurological Sciences, Glasgow, between 1968-72 (151 cases) and 1981-82 (112 cases)

It is possible to differentiate between primary and secondary thyroid squamous cell carcinoma, on the basis of combined evidence from clinical examination and endoscopic, pathological and radiological evaluation. Such differentiation is important, as the prognosis for primary squamous cell carcinoma is uniformly poor irrespective of treatment, and the most suitable option may be supportive therapy. Treatment for secondary squamous cell carcinoma of the thyroid varies with the site and extent of spread of the primary tumour.

beta-Amyloid precursor protein (beta-APP), a normal constituent of neurons which is conveyed by fast axonal transport, has been found to be a useful marker for axonal damage in cases of fatal head injury. Immunocytochemistry for beta-APP is a more sensitive technique for identifying axonal injury than conventional silver impregnation. This study was designed to determine how quickly evidence of axonal damage and bulb formation appears. Using this method a variety of brain areas were studied from 55 patients who died within 24 h of a head injury. Immunocytochemical evidence of axonal injury was first detected after 2 h survival, axonal bulbs were first identified after 3 h survival, and the amount of axonal damage and axonal bulb formation increased the longer the survival time.

SUMMARY Deep intracerebral (basal ganglia) haematomas were found post mortem in 63 of 635 fatal non-missile head injuries. In patients with a basal ganglia haematoma, contusions were more severe, there was a reduced incidence of a lucid interval, and there was an increased incidence of road (22%) females; the age range was 9 weeks to 89 years; and the duration of survival ranged from 1 hour to 14 years 3 months. The majority of the injuries were attributable to road traffic accidents (335; 53%), or to falls (221; 35%). Of the remaining 79 cases, 31 were assaults, three were crush injuries, 14 were other types of injury, while in the remaining 31 cases the circumstances of the injury were not known. There was a fracture of the skull in 478 (75%) of the cases. The clinical records were assessed with particular reference to any deterioration in the level of consciousness after a lucid interval, defined as whether or not the patient had talked a short time after the injury.'0 A full post-mortem examination was undertaken in every case and the brain removed by one of us so that a careful note could be made of any extracerebral lesions, such as the tightness of the dura, and the presence of blood in the extradural or subdural spaces. The brains were then suspended in 10% formol saline for 3-4 weeks before dissection: the cerebral hemispheres were sliced in the coronal plane, the cerebellum at right angles to the folia, and the brain stem horizontally.'" Comprehensive histological studies were undertaken in 434 of the 635 cases. These included the preparation of 30 pm celloidin sections stained by Nissl's method with cresyl violet and by Woelke's modification of Heidenhain's technique for myelin. Representative blocks were also taken from the cerebral hemispheres, the cerebellum