Therapeutic Effects of Dimethyl Fumarate on the Rat Model of Brain Ischemia

Abstract Blood-brain barrier (BBB) disruption, inflammation, and cell death are major pathogenic mechanisms in ischemic stroke. Dimethyl fumarate (DMF) has anti-inflammatory and immune-modulatory effects. So, this study aimed to elucidate the effects of DMF on brain ischemia in the middle cerebral artery occlusion (MCAO) model. 69 Sprague-Dawley male rats were allocated into a sham group that was just subjected to surgery stress; vehicle and DMF groups, after MCAO, received vehicle or 30 mg/kg DMF for three days. Neurological scores were evaluated every day. BBB disruption was evaluated by the extravasation of Evans blue. In addition to the measurement of brain water content, the total and infarct volume, numerical density, and the total number of neurons, non-neurons, and dead neurons in the right cortex were estimated by stereological methods. RT-PCR was done to analyze the expression levels of NF-κB and Nrf2. Although brain ischemia treatment with DMF did not have a significant effect on the infarction size, it improved neurobehavioral function, BBB disruption, cerebral edema, increased number of neurons, and expression of Nrf2. It also decreased the number of dead neurons and the expression of NF-κB. DMF beneficial effects on stroke may be mediated through both increase of the Nrf2 and decrease of NF-κB expression

Relationship between the Expression of α-syn and Neuronal Apoptosis in Brain Cortex of Acute Alcoholism Rats / 法医学杂志

OBJECTIVES@#To observe the changes of expression of α-synuclein （α-syn） and neuronal apoptosis in brain cortex of acute alcoholism rats and to explore the mechanism of the damage caused by ethanol to the neurons.@*METHODS@#The model of acute alcoholism rat was established by 50% alcohol gavage. The α-syn and caspase-3 were detected by immunohistochemical staining and imaging analysis at 1 h, 3 h, 6 h and 12 h after acute alcoholism. The number of positive cell and mean of optical density were detected and the trend change was analyzed. The variance analysis and t-test were also performed.@*RESULTS@#The number of α-syn positive cell and average optical density in brain cortex of acute alcoholism rat increased significantly and peaked at 6 hour with a following slight decrease at 12 h, but still higher than the groups at 1 h and 3 h. Within 12 hours after poisoning, the number of caspase-3 positive cell and average optical density in brain cortex of rats gradually increased.@*CONCLUSIONS@#The abnormal aggregation of α-syn caused by brain edema and hypoxia may participate the early stage of neuronal apoptosis in brain cortex after acute alcoholism.

Encefalopatía hepática fulminante vinculada a hiperintensidad de la corteza cerebral en la resonancia magnética / Fulminant hepatic encephalopathy vinculated with hyperintensity of the cerebral cortex in magnetic resonance

Background: The presence of manganese deposits in basal ganglia is an expression of chronic liver damage in neuroimaging, whereas diffuse edema of the white matter and hyperintensity of the internal capsule are seen in MRI in acute decompensation. In fulminant encephalopathy, changes in intensity in the cerebral cortex have been described, suggesting different pathogenic aspects. Purpose: To describe and try to interpret hyperintensities images of the cerebral cortex in fulminant hepatic encephalopathy. Case report: A 42 years old woman, with history of hyperthyroidism treated with propylthiouracil developed abdominal pain, choluria and general malaise, without fever. At admission, she had jaundice, elevated liver enzymes, and hyperammronemia of 481 ug. She developed progressive impairment of consciousness falling into a non-reactive coma with intermediate size and poorly reactive pupils, absence of oculocephalic reflexes and diminished osteotendinous reflexes, with indifferent plantar reflexes. Brain CT showed brain edema without focal lesions. The MRI showed hyperintense signal abnormalities in the fronto-parietal cortex in T2 and FLAIR with restriction in difussion sequency. She became brain dead. Comment: These exceptional images on MRI are considered an expression of cytotoxic damage, consistent with high levels of ammonium in fulminant hepatic encephalopathy. The swelling of astrocytes and cortical neurons is caused by the accumulation of intracellular glutamine, highly osmophilic, and explains the restriction on the difussion and lower values in the ADC. Interstitial edema would be part of the chronic forms by acquisition of compensatory mechanisms capable of preventing the accumulation of glutamine.

Antecedentes: La presencia de depósitos de manganeso en los núcleos basales es una expresión neuroimagenológica de daño hepático crónico, así como el edema difuso de la substancia blanca y la hiperintensidad de la cápsula interna con RM en descompensaciones agudas. En encefalopatías fulminantes se ha visualizado cambio de intensidad en la corteza cerebral, sugiriendo aspectos patogénicos distintos. Propósito: Describir e intentar interpretar imágenes hiperintensas de la corteza cerebral en una encefalopatía hepática fulminante. Caso clínico: Mujer de 42 años, hipertiroidea en tratamiento con propiltiouracilo. Consultó por dolor abdominal, coluria y compromiso del estado general, sin fiebre. Ingresó con ictericia, enzimas hepática elevadas, e hiperamonemia de 481 ug. Desarrolló progresivo compromiso de conciencia cayendo en un coma no reactivo, con pupilas de tamaño intermedio pobremente reactivas, ausencia de reflejos oculocefálicos y reflejos osteotendíneos apagados, con reflejos plantares indiferentes. TAC de cerebro mostró edema cerebral, sin lesiones focales. La RM definió áreas hiperintensas en la corteza fronto-parietal en T2 y FLAIR, que presentaban incremento de señal en la difusión. Evolucionó hasta la muerte cerebral. Comentario: Estas imágenes excepcionales en la RMson consideradas expresión de daño citotóxico, en concordancia con los altos niveles de amonio de una encefalopatía hepática fulminante. El edema de astrocitos y neuronas corticales se origina por la acumulación de glutamina intracelular, altamente osmofílica, y explica la restricción en la difusión y valores menores en el ADC. El edema intersticial, sería atributo de las formas crónicas, debido a la adquisición de mecanismos compensatorios capaces de impedir la acumulación de glutaminas.

Encefalopatía aguda en un paciente tratado con inmunoglobulina endovenosa por un síndrome de Guillain-Barré / Acute encephalopathy associated with the use of intravenous immunoglobulin. Report of one case

Adverse reactions to intravenous immunoglobulin (ivIg) therapy, such as anaphylaxis, acute encephalopathy, aseptic meningitis, or thrombotic phenomena are uncommon. We report a 58-year-old man with hypertension presenting with muscle weakness which led to paraparesia and respiratory failure. With the diagnosis of Guillain-Barré syndrome (GBS), he was treated with ivIg. He developed an acute encephalopathy few hours after the administration of ivIg, with a decreased level of consciousness and agitation. A CT scan revealed moderate and diffuse brain edema. Encephalopathy resolved 96 hours after ivIg withdrawal and use of plasma exchange. A CT scan performed seven days after showed the resolution of brain edema.

Forensic clinical analysis on 25 cases of traumatic cerebral infarction / 法医学杂志

OBJECTIVE@#To investigate characteristics of forensic clinical identification on traumatic cerebral infarction(TCI).@*METHODS@#Twenty-five cases of TCI were analyzed retrospectively, including the general situation, location of infarction and clinical feature.@*RESULTS@#TCI occurred primarily in children and elderly. All the cases had definite cerebral trauma which was located mainly in the regions of basal ganglia-internal capsule, frontal, temporal and parietal cerebral cortex.@*CONCLUSION@#The consequence of TCI has direct correlation with location of cerebral infarction. More attention should be paid to this issue in forensic practice.

Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

OBJECTIVE: We analyzed the diffusion and perfusion characteristics of acute MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode) lesions in a large series to investigate the controversial changes of the apparent diffusion coefficient (ADC) that were reported in prior studies. MATERIALS AND METHODS: We analyzed 44 newly appearing lesions during 28 stroke-like episodes in 13 patients with MELAS. We performed a visual assessment of the MR images including the ADC and perfusion maps, comparison of the ADC between the normal and abnormal areas, comparison of % ADC between the 44 MELAS lesions and the 30 acute ischemic infarcts. In addition, the patterns of evolution on follow-up MR images were analyzed. RESULTS: Decreased, increased, and normal ADCs were noted in 16 (36%), 16 (36%), and 12 (27%) lesions, respectively. The mean % ADC was 102 +/- 40.9% in the MELAS and 64 +/- 17.8% in the acute vascular infarcts (p < 0.001), while perfusion imaging demonstrated hyper-perfusion in six acute MELAS lesions. On follow-up images, resolution, progression, and tissue loss were noted in 10, 4, and 17 lesions, respectively. CONCLUSION: The cytotoxic edema gradually evolves following an acute stroke-like episode in patients with MELAS, and this may overlap with hyper-perfusion and vasogenic edema. The edematous swelling may be reversible or it may evolve to encephalomalacia, suggesting irreversible damage.

Peritumoral brain edema in intracranial meningiomas / Edema peritumoral em meningiomas intracranianos

Occurrence of peritumoral brain edema (PBE) in meningiomas has been associated with several factors in recent years, although its pathophysiological mechanism has not yet been fully elucidated. The aim of this study was to analyze the correlation between the presence / degree of PBE and factors such as gender, age, size and histological subtype of tumor. We analyzed the MRI images of 74 patients operated on Hospital Beneficência Portuguesa de Porto Alegre for the presence / degree of PBE and data was statistically correlated with the parameters of the patient. PBE was present in 70.1 percent of patients. Tumors with higher volume had more PBE. Tumors of the olfactory groove showed more PBE than sphenoid wing and parassagittal tumors. Transitional subtype showed more PBE than fibroblastic and meningothelial subtypes.

A presença de edema cerebral peritumoral (ECP) em meningiomas tem sido associada a diversos fatores nos últimos anos, embora o seu mecanismo fisiopatológico ainda não tenha sido inteiramente elucidado. O objetivo desse estudo foi analisar a correlação entre a presença/grau de ECP e fatores como sexo, idade, volume e subtipo histológico do tumor. Foram analisadas imagens de RM de 74 pacientes operados no Hospital Beneficência Portuguesa de Porto Alegre quanto à presença/grau de ECP e os dados correlacionados estatisticamente com os parâmetros do paciente. ECP estava presente em 70,1 por cento dos pacientes. Tumores com maior volume apresentaram mais ECP. Tumores da goteira olfatória apresentaram mais ECP que os da asa do esfenóide e que os parassagitais. Meningiomas transicionais apresentaram mais ECP que os fibroblásticos e que os meningoteliais.

Correlação da topografia tumoral e edema peritumoral com a resposta terapêutica à administração intranasal do álcool perílico nos gliomas malignos recidivos / Correlation of tumor topography and peritumoral edema with therapeutic response to a new approach for recurrent malignant gliomas, intranasal administration of perillyl alcohol

Objetivo: Avaliar a correlação da topografia tumoral e edema peritumoral com a resposta terapêutica à administração intranasal do álcool perílico (AP) em uma coorte de pacientes com gliomas malignos recidivos. Métodos: Os autores revisaram retrospectivamente 67 pacientes com gliomas malignos recidivos que receberam administração intranasal de 440 mg de AP diariamente. Parâmetros avaliados incluíram aspectos clínicos e os de neuroimagem. Avaliação clínica incluiu dados demográficos, sintomas iniciais e sobrevida global. Dados de imagem incluíram topografia tumoral, volume tumoral, presença de desvio da linha média eextensão de edema peritumoral. Análise bioestatística foi realizada usando testes log rank. Sobrevida global foi medida e analisada pelo método de Kaplan Meier, incluindo intervalos de confiança de 95 por cento. Resultados: Um total de 67 pacientes foi investigado, 52 (77,6 por cento) com glioblastoma (GBM), 10 (14,9 por cento) com astrocitoma anaplásico (AA) e 5 (7,4 por cento) com oligodendrioglioma anaplásico (OA). Todos os cinco pacientes com AO apresentaram tumor de localização lobar. Nos AA, oito casos estavam localizados em região talâmica e dois em região lobar, enquanto que, nos GBM, 11 casos de localização talâmica e 41 lobares. A relação volume tumoral e edema peritumoral foi observada. Pacientes com regressão tumoral e edema peritumoral apresentaram resposta positiva enquanto que aqueles com regressão tumoral sem regressão do edema peritumoral não apresentaram boa evolução clínica. Pacientes com gliomas profundos sobreviveram significativamente mais tempo do que aqueles com gliomas lobares (log rank test, p = 0,0003). Presença de desvio da linha média (> 1 cm) foi estatisticamente significante como fator de risco para a sobrevida mais curta (log rank test,p = 0,0062). Conclusões...

To evaluate the correlation of tumor topography and peritumoral brain edema with the therapeutic response of intranasal administration of perillyl alcohol (POH) in a cohort of patients with recurrent malignant gliomas. Methods: We retrospectively reviewed 67 consecutive patients with recurrent malignant gliomas who received administration intranasal of POH 440 mg daily. The parameters evaluated were clinical features and the neuroimaging findings. Clinical data included demographics, initial symptoms, and overall survival.Imaging analysis included tumor topography, tumor size, presence of midline shift and extent of peritumoraledema. Biostatistics was carried out using log rank tests. Overall survival was measure and analyzedby Kaplan Meier method including 95% confidence intervals. A total of 67 patients were investigated,52 (77.6%) with glioblastoma (GBM), 10 (14.9%) with anaplastic astrocytoma (AA) and 5 (7.4%) withanaplastic oligodendroglioma (AO). All five AO had lobar localization, AA were lobar in 8 cases and deep in 2 cases, whereas GBM were lobar in 41 cases and deep in 11 cases. Results: A relationship between the tumor size and the volume of peritumoral brain edema (PTBE) was observed. Patients with regression of the tumor and PTBE had positive response whereas those with regression of the tumor without PTBE regression had poor prognosis. Patients with deep tumors survived significantly longer than those with lobar gliomas (log rank test, p=0.0003). Presence of midline shift (> 1 cm) was a statistically significant risk factor for shorter survival (log rank test, p=0.0062). Conclusions...

Intracranial meningiomas: magnetic resonance imaging findings in 78 cases

OBJECTIVE: To present the magnetic resonance (MR) imaging findings of 78 patients with meningiomas diagnosed in a single institution. METHOD: 78 patients with histological proven intracranial meningioma were studied. There were 52 female and 26 male patients (median=56 years). All MR imaging examinations were performed with 1.5-T MR imaging unit with standard protocol. The images were studied by two neuroradiologists, who reached the decisions regarding the findings by consensus. RESULTS: Most of the tumors showed low signal on T1- (60 percent) and high signl on T2- (68 percent) and FLAIR (69 percent) weighted images. Also, the lesions showed heterogeneous signal on T1 (60 percent), T2 (68 percent) and FLAIR (64 percent) sequences. After contrast administration, 83 percent (n=65) of the tumors presented acentuated and 17 percent (n=13) showed moderate enhancement. The tumors were located in the frontal lobe in 44 percent of the cases, in the parietal lobe in 35 percent, the occipital lobe in 19 percent and the temporal lobe in 12 percent of the patients. Areas of vasogenic edema around the tumors were seen in 90 percent of the cases. Twenty six per cent of the cases showed bone infiltration, and the dural tail sign was seen in 59 percent of the tumors. CONCLUSION: Intracranial meningiomas usually show heterogeneous low signal on T1- and high signal on T2-weighted and FLAIR images, with intense enhancement after contrast administration. The frontal and parietal lobes are commonly affected. In addition, brain edema, dural tail sign and bone infiltration are the most frequent associated findings.

OBJETIVO: Apresentar os achados de ressonância magnética (RM) de 78 pacientes com meningioma intracraniano diagnosticados numa única instituição. MÉTODO: 78 pacientes com diagnóstico histológico de meningioma intracraniano foram estudados. Cinqüenta e dois eram femininos e 26 masculinos (mediana=56 anos). Todos os exames de RM foram realizados num aparelho de 1.5 Tesla, com protocolo padrão. As imagens foram avaliadas por dois neurorradiologistas, os quais estabeleceram os achados por consenso. RESULTADOS: A maioria dos tumores apresentou baixo sinal em T1 (60 por cento) e alto sinal em T2 (68 por cento) e FLAIR (69 por cento). Além disso, as lesões demonstraram sinal heterogêneo em T1 (60 por cento), T2 (68 por cento) e FLAIR (64 por cento). Após a administração intravenosa de contraste, 83 por cento dos tumores apresentaram realce acentuado e 17 por cento moderado. Os tumores estavam localizados no lobo frontal em 44 por cento dos casos, no parietal em 35 por cento, no occipital em 19 por cento e no lobo temporal em 12 por cento dos casos. Areas de edema vasogênico foram observadas em 90 por cento dos pacientes. Vinte e seis por cento dos casos apresentaram sinais de infiltração óssea e o sinal da cauda dural foi visto em 59 por cento dos tumores. CONCLUSÃO: Meningiomas intracranianos em geral apresentam sinal heterogêneo, baixo em T1 e alto em T2 e FLAIR, com intenso realce pelo contraste. Os lobos frontais e parietais são com freqüência acometidos. Além disso, edema vasogênico, sinal da cauda dural e infiltração óssea são os achados associados mais comuns.

Meningeoma de goteira olfatória: relação entre achados clínico-radiológicos e índice proliferativo (Mib-1) / Olfactory groove meningioma: correlation between clinicoradiological features and proliferative index (Mib-1)

OBJETIVO: O objetivo deste estudo é correlacionar achados clínicos, radiológicos e índice proliferativo em meningeomas da goteira olfatória e analisar possíveis fatores preditivos de recidiva tumoral. MÉTODO: Foram estudados 15 pacientes portadores de meningeoma de goteira olfatória. O exame imuno-histoquímico foi realizado através do índice proliferativo calculado a partir da expressão do MIB-1. RESULTADOS: Houve relação estatisticamente significativa entre volume tumoral e edema. Não houve relação significativa entre índice proliferativo, volume tumoral, edema, idade do paciente e alterações da base do crânio. Dois pacientes que apresentaram recidiva tumoral possuíam índice proliferativo maior que a média. CONCLUSÃO: Tumores maiores são mais susceptíveis ao desenvolvimento de edema cerebral. O índice proliferativo provavelmente está associado a recidiva tumoral, principalmente em pacientes com hiperostose e ressecções cirúrgicas parciais.

Dynamic observation of brainstem auditory evoked potential and pathological changes of the brain after closed brain injuries in rats / 法医学杂志

OBJECTIVE@#To investigate the dynamic experiences of pathological changes in brain and the injured role of brainstem auditory evoked potential (BAEP) after closed Mild Traumatic Brain Injury (MTBI) in rat.@*METHODS@#A closed diffuse brain injury model was successfully produced in rat by hit the parietal bone with a spring-droved steel stick. The auditory brainstem response evoked by click at 50Hz stimulating frequency were recorded at pre-trauma, 15 min and 1, 3, 6, 12 h and 1, 2, 4, 7, 10, 14, 21 d after brain injury. The pathological changes of brain were observed under light microscope and the brain edema was detected by wet weight/dry weight rations.@*RESULTS@#The I-V, III-V of BAEP wave inter peak latency (IPL) in MTBI group increased immediately in 15 minutes after injury. The III, V wave peak latency (PL) and I-V, III-V wave IPL became longer than the pre-trauma level in 6, 12 h post-injury (P<0.05). The III, V wave PL and I - III, I - V, III - V wave IPL became longer than the pre-trauma level in 1, 2 d after injury (P < 0.001), the BAEP retuned to normal level in 14 d after brain injury. At 15 minutes after injury, the water content in brain increased and met its peak in 1 d, decreased gradually in 4 d, then decreased slowly and returned to normal level in 10 d after injury.@*CONCLUSION@#The regular changes of BAEP could be an objective tool for evaluating hearing dysfunction after closed mild diffuse traumatic brain injury.

Time-dependent expression of astroglial S100beta following diffuse brain injury in rats / 法医学杂志

OBJECTIVE@#To investigate the dynamics of the induction of S100beta in different parts of rat brain following the diffuse brain injury.@*METHODS@#Immunohistochemistry and auto-image analysis were to determine the expression of astroglial S100beta after diffuse brain injury in rats. Forty rats were distributed into groups according to injury time of 30min, and2,4,12,24h, and 3,6 d after diffuse brain injury, and normal rats as control.@*RESULTS@#The number of S100beta positive cells in the four areas increased significantly followed by a decrease, and then a further increase. The expression of S100beta could be detected increasing in 2h, and increased significantly in 4h, and it reached apex 12h after DBI, and decreased gradually to the level less than normal 3d, and returned to normal 7d following injury. In the postmortem injury groups, there were no significant changes in anti-S100beta immunoreactivities in four areas of brain compared to the control group.@*CONCLUSION@#The present study showed the time-dependent expression of S100beta is obvious following diffuse brain injury, and suggested S100beta be suitable as a marker for brain injury age determination.

Edema and malignancy in meningiomas

OBJETIVO: Nos últimos anos têm-se descrito alguns subtipos de meningiomas de comportamento peculiarmente agressivo. Muitas tentativas têm sido feitas no intuito de estabelecer critérios imagenológicos ou histopatológicos de malignidade. O objetivo desse estudo é avaliar, através de Tomografia Computadorizada e Ressonância Nuclear Magnética o grau de edema peritumoral e seu volume, correlacionando-os com a classificação histológica da OMS. As causas relatadas de edema peritumoral e sua possível correlação histológica foram também revistos. MÉTODOS: Foram estudados 55 casos de meningiomas operados no Hospital das Clinicas (FMUSP) entre Setembro de 1993 e Setembro de 1997. O grau de edema segundo a classificação de Ide et al. (1995) foi comparado com a classificação da OMS. RESULTADOS: Os achados relativos a edema foram: edema grau 0 - 28 pacientes; grau I - 19 pacientes; grau II - 8 pacientes. A classificação histológica demonstrou: meningiomas benignos - 43 casos; meningiomas atípicos - 11 casos meningioma maligno - 1 caso. Demonstrou-se uma correlação significativa (p = 0,0089) entre o grau de edema dos meningiomas e suas características histológicas. CONCLUSÕES: Esses resultados sugerem que o grau de edema avaliado imagenologicamente pela Tomografia Computadorizada e Ressonância Nuclear Magnética pode ser um importante fator preditivo da gradação histológica dos meningiomas.

Experimental study of rapid versus slow sagittal sinus occlusion in dogs.

BACKGROUND: Clinical, radiological, postmortem and experimental studies are not enough for the definition of pathophysiological differences between rapid and slow-progressing cerebral venous system obstruction. AIMS: An experimental study was conducted to set some physiopathological differences between rapid and slow occlusion of the superior sagittal sinus. SETTINGS AND DESIGN: Eighteen dogs categorized into 3 groups were chosen as test subjects. The three groups were the rapid occlusion, slow occlusion and the control study groups and each group had six subjects. MATERIAL AND METHODS: Intracranial pressure values, histopathological findings, and the degree of cerebral edema formation, estimated by measuring the water content ratio of the brain and the angiographic results in the 2 different groups of subjects that underwent rapid and slow superior sagittal sinus obstruction were compared with that of the control subjects. STATISTICAL ANALYSIS: Statistical analysis was performed using GraphPad Prisma V.3 statistical software. Variables of the 3 groups were compared using non-parametric Kruskal Wallis ANOVA test and multiple comparisons were made using Dunn's multiple test. The comparison of initial and terminal intracranial pressure values obtained before and after the sinus occlusion, was made using the Wilcoxon test. A probability value of less than 0.05 was regarded as significant. RESULTS AND CONCLUSIONS: Comparison of the water content ratio of the brain in the 3 groups, the difference between the initial and terminal intracranial pressure values of the rapid occlusion study group, and the difference between the terminal intracranial pressure values of the 3 groups was statistically significant (P<0.05). Dunn's Multiple Comparison Test yielded significant differences in the water content ratio of the brain and in the intracranial pressure values between the rapid occlusion study group and the control group (P<0.05). Moreover, histopathological and radiological examination disclosed more prominent brain edema findings, and less apparent collateral venous flow in the rapid occlusion study group than in the slow occlusion one. To conclude, the clinical severity of sinus occlusion seems directly related to the quickness of the occlusion and the capacity of the collateral venous system.

Strangulation injury, a fatal form of child abuse.

Strangulation is a common method of committing murder, though underreported in Indian literature. We managed a girl child, victim of child abuse who later succumbed to its neurological complications. This case report describes the clinical features associated with such injuries and complications which should be anticipated in such cases.

Tumefaçäo cerebral congestiva em vítimas fatais de acidentes de trânsito: frequência e associaçäo com outras lesöes cranioencefálicas / Congestive brain swelling in victims of fatal road accident: frequency and association eith other head injury lesions

Realizou-se estudo anatomopatológico macro e microscópico do encéfalo de 120 vítimas fatais de acidente de trânsito. A tumefação cerebral congestiva (TCC) ocorreu em 21 (17,5 por cento) pacientes. Consoante com a tumefação cerebral, que determina aumento volumétrico do encéfalo, foi encontrado aumento do peso médio do encéfalo. A contusão cerebral foi a lesão mais frequentemente associada com a TCC (76,2 por cento), enquanto os hematomas intracranianos foram observados em quase metade dos casos.