Aim: To study the types of brainstem injury and their clinical and radiological presentation and to correlate the macroscopic and microscopic findings with the above clinical and radiological imaging. Materials and methods: 50 patients who sustained fatal head injury and died in our hospital were taken up for this study. Patient’s age, time of injury, mode of injury, level of consciousness, the site of impact of head injury, other associated injuries and survival period were collected. Radiological evidence of fracture, hematoma, contusions, edema, and basal cistern obliteration were noted. At the time of autopsy, the brainstem was examined looking for areas of gross contusion, hematomas and edematous changes. The brainstem specimens were stained with haematoxylin eosin stain and the slides were studied under microscope with low and high power. Brainstem lesions were categorized as primary and secondary depending on macroscopic and microscopic appearance. Conclusion: The study has shown that the lateral impact during trauma has resulted mostly in secondary brainstem lesions. In majority of cases the primary brainstem lesions have been associated with basal skull fractures whereas majority of secondary brainstem lesions were associated with vault fractures. In primary brainstem lesions gross haemorrhagic lesions were seen in dorsal, dorsolateral aspect of midbrain and dorsal aspect of upper pons. In secondary brainstem lesions gross hemorrhagic lesions were seen in the midline and paramedian aspect of tegmentum of midbrain and pons. 

Keywords: brainstem injury; diffuse axonal injury; traumatic brain injury