Pathological Spectrum and β-APP Immunoreactivity as a Diagnostic Tool of Diffuse Axonal Injury following Traumatic Brain Injury: A Novel Classification

Meenakshi Sharma; Arulselvi Subramaniam; Kangana Sengar; Vaishali Suri; Deepak Agrawal; Nabarun Chakraborty; Ravindra Mohan Pandey; Rajesh Malhotra; Sanjeev Lalwani

doi:10.1055/s-0043-1761926

Journal of Laboratory Physicians, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(03): 399-408
DOI: 10.1055/s-0043-1761926

Original Article

Pathological Spectrum and β-APP Immunoreactivity as a Diagnostic Tool of Diffuse Axonal Injury following Traumatic Brain Injury: A Novel Classification

Meenakshi Sharma

¹Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Arulselvi Subramaniam

²Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Kangana Sengar

²Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Vaishali Suri

³Neuropathology Laboratory, Center for Neurosciences, All India Institute of Medical Sciences, New Delhi, India

,

Deepak Agrawal

⁴Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

,

Nabarun Chakraborty

¹Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Ravindra Mohan Pandey

⁵Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

,

Rajesh Malhotra

⁶Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Sanjeev Lalwani

¹Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

› Institutsangaben

Abstract

Aim Different deposition patterns and grading systems used to define and identify DAI remain discordant and to date these are a challenge in clinical practice. Our main objective was to study the post-mortem axonal changes and develop a grading system to identify DAI on the basis of histopathological and immunoreactive β-amyloid precursor protein (β-APP) observations in severe TBI cases.

Methods Prospective study with 35 decedents with sTBI (GCS score ≤ 8) was conducted and samples were collected from three different sites–corpus callosum, thalamus and brain stem. Serial sections from each site were stained with hematoxylin and eosin (H&E), and immunohistochemistry (IHC) of β-APP.

Results We developed a grading system based on histopathological characteristics to assess the overall damage of axonal injury. We found maximum histopathological changes in cases with prolonged stay. Corpus callosum showed maximum changes in both gradings. Curiously, we also detected axonal swellings with H&E staining. Usually neglected, the thalamus also showed significant histopathological and immunoreactive changes for sTBI.

Conclusion Our study based on histopathological and β-APP scoring system to define and identify DAI thus facilitates accurate diagnosis of DAI post mortem, which has forensic implications, and may further contribute toward survival and improvement of quality of life of sTBI patients.

Keywords

traumatic brain injury - diffuse axonal injury - β-app - H&E stain - forensic pathology

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