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Pathogenesis Primary brain stem injury is the result of the direct effect of the trauma which results in its distortion and displacement. Kalyanaraman and Ramamurthi (1969) reported 42 cases of brain stem injury among 1100 cases of head injury patients admitted to their head injury unit in 18 months.[[1]] As late at 2007, Shukla et al. stated, "Several autopsy studies of head injury are available, but pathology of brain stem and hypothalamus injury are addressed in very few of them. "In many general surgical works today the diagnosis of primary brain stem injury amounts to pronouncement of death sentence" (Kalyanaraman and Ramamurthi 1969) It is interesting that around the same time as the above statement on ominous saying in some centers in Delhi acquired a similar predicament, "Yeh to brain stem ho gaya ab iska kuch nahi ho sakta" (He has become brain stem, now nothing can be done about it). While brain stem hemorrhage is more common in the secondary group of brain stem lesions, these are not uncommon in the primary injury especially in the lateral part of the mid-brain, the superior cerebellar peduncle, and rostral pons. [Extracted from the article]