A retrospective and prospective study of cerebral tissue pulmonary embolism in severe head trauma

In an attempt to determine the incidence of pulmonary embolization of cerebral tissue as the result of severe head trauma with and without dural penetration, we have collected the autopsy reports at our institution of all head injury victims over the past 3.5 years. The retrospective and prospective histologic examination of these cases revealed a total of 10% to have emboli of cerebral tissue within the pulmonary vasculature. Immunohistochemical staining of the emboli confirmed the neural origin of the tissue. The dura mater proved to be intact in 70% of the cases of cerebral embolization. We feel this provides evidence that embolization of cerebral tissue may occur without rupture of the dura and/or large venous sinuses. This observation is of clinical as well as forensic importance, as cerebral tissue emboli are a rich source of thromboplastin in the systemic and pulmonary vasculature and may contribute to the morbidity and mortality of head injuries.