Influence of alcohol intoxication on the survival period in patients with subdural hemorrhage

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Abstract

BACKGROUND: Traumatic brain injury is an urgent problem in forensic medical examination, and subdural hematoma is considered the most fatal among them. In forensic medical practice, the outcomes of subdural hematoma should be understood depending on its volume to represent the pathohistological evolution of subdural hematoma and determine the essence of brain damage at the same time.

AIM: To evaluate the influence of alcohol intoxication on the survival period in patients with subdural hemorrhage.

MATERIALS AND METHODS: A retrospective study was conducted on 42 deaths from subdural hematoma, of which two groups were identified: those who died before medical care (n=20) and those who received medical care in a hospital (n=22). The injury circumstances, the blood volume spilled under the dura mater, the presence and degree of alcohol intoxication, and the level of consciousness on the Glasgow coma scale were recorded. Histological examination of a subdural hematoma was performed to determine its prescription.

RESULTS: Subdural hematoma is commonly caused by street injuries and traffic accidents. Hematomas are combined with skull fractures in 52.3% of cases, leptomeningeal hemorrhages in 73.8%, bruises in 81%, and cerebral edema in 88%. Unilateral subdural hematoma is more common than bilateral. The fact of alcoholic intoxication was recorded in most victims, whereas the ethyl alcohol concentration in the blood of persons who died before medical care was 2 times higher. Significant correlations were observed between the degree of impaired consciousness on the Glasgow coma scale and the concentration of ethyl alcohol in the blood (r=−0.701, p <0.05) and between the volume of subdural hematoma (r=−0.526, p <0.05) and hospitalization period (r=0.559, p <0.05).

CONCLUSION: Persons with subdural hemorrhage in a state of high degree of alcohol intoxication, as a rule, die before medical care is provided to them. Similarly, if help was provided, the outcome is most often unfavorable with a shorter survival period even in the presence of a small hematoma. Histological examination is currently the most optimal method in terms of determining the prescription of subdural hematoma.

About the authors

Nikita S. Averkin

Regional Bureau of Forensic Medical Examination; Penza State University

Author for correspondence.
Email: averkin.n@list.ru
ORCID iD: 0000-0001-8129-9400
SPIN-code: 7973-2100

MD, Cand. Sci. (Med)

Russian Federation, Penza; Penza

Arkadiy P. Stolyarov

Regional Bureau of Forensic Medical Examination

Email: sudmed_penza@mail.ru
ORCID iD: 0000-0001-6946-9059
SPIN-code: 3649-4766

MD, Cand. Sci. (Med)

Russian Federation, Penza

Evgeniy A. Kharitonov

Regional Bureau of Forensic Medical Examination

Email: haritonovdoc@mail.ru
ORCID iD: 0009-0004-2680-7432
SPIN-code: 9183-6366

MD, Cand. Sci. (Med)

Russian Federation, Penza

Irina S. Zhivankina

Penza State University

Email: izhivankina@list.ru
ORCID iD: 0000-0002-8927-2584
Russian Federation, Penza

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Supplementary files

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2. Fig. 1. Subdural hematoma with an established prescription of 12–24 hours. Coloring: hematoxylin and eosin, ×400.

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3. Fig. 2. Blood coagulation under the dura mater with an established prescription of 24–48 hours. Coloring: hematoxylin and eosin, ×400.

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