Diffuse traumatic degeneration of the cerebral gray matter.

Diffuse cerebral cortical degeneration, as demonstrated in the following case, appears to be an unusual if not unique reaction to trauma. Cerebral contusions, lacerations, and intracranial hemorrhages are common lesions that are related directly to external violence. Rarer focal lesions associated with head injury include delayed apoplexy, central traumatic softening, and non-hemorrhagic cortical degenerations some distance from the primary site of injury. Widespread petechial hemorrhages in the white matter constitute one form of diffuse traumatic alteration. Another type was described recently by Strich (I), who reported 5 cases of longstanding dementia and decerebration associated with extensive traumatic degeneration of the white matter without significant cortical changes. Clinically, our case somewhat resembled those of Strich. A boy, 14 years of age, survived a blow to the head for 10 months, mute, demented, and with flexion-contractures. The lesions were widespread, but conversely involved the gray matter primarily. Mechanical disruption of the cerebral parenchyma and evidence of pressure or gross hemorrhage were absent. This case appears to demonstrate the lethal effect of trauma on neurons, independent of sundering of the tissue.