11-13 NeuroPATH Trauma

Question 1

Much of this is repeat from earlier lectures

Answer 1

So review neuroimaging

Question 2

Prognosis s/p GSW?

Answer 2

—bi-hemispheric?

—level of consciousness?

Question 3

Alteration of consciousness in SDH

Answer 3

due as much to rotation deceleration as to hematoma

Question 4

Deceleration injuries

Answer 4

Differential rotational deceleration of white matter, grey matter and CSF
—Causes stresses at interfaces
—Tearing of axons and contusions

Question 5

Chronic SDH

Answer 5

—Occurs in elderly (underlying brain atrophy increases distance between skull and cortex, stretches bridging veins even more); esp when anti-coag’d
—Onset of symptoms weeks following relatively minor trauma
—Confusion, HA, focal deficit
—Iso or hypodense (darker on CT) collection along cerebral convexity (b/c older blood)

Question 6

Monro-Kellie Doctrine

Answer 6

Monro-Kellie Doctrine = blood + CSF + brain

Question 7

ICP ref range

Answer 7

<12mmHg

Question 8

Cerebral Perfusion Pressure
—equation
—Why measure?
—ref range?

Answer 8

CPP = MAP - ICP
—better number to use to follow head trauma pt, b/c monitoring was not assoc’d w/ better outcomes
—w/ elev. perfusion pressure, cerebral blood flow can be maintained w/ reduced blood volume and thus a lower ICP = Rovner Doctrine
—RR = >70mmHg*
*hotly debated

Question 9

Rx in spinal cord trauma?

Answer 9

methylprednisolone was the standard of care for acute spinal cord injury
—now not sure?

Question 10

Clinical Mgmt of head trauma

Answer 10

HX: Mechanism of injury? ∆ in mental status?
PE: focal deficits? trend in mental status? GCS?
IMAGING: CT/MRI

Question 11

Concussion

Answer 11

—totally reversible
—transient cerebral malfunction
—may have brief LOC or loss of postural tone

Question 12

Contusion

Answer 12

crowns of gyri damaged by blunt force trauma
—common in anterior frontal and temporal lobes because calvarian is right there and brain runs into it
—gliotic surface —> old lesions “plaques jaunes”

Question 13

problems w/ temporal bone fx

Answer 13

middle meningeal artery is underneath —> epidural hematoma

Question 14

outcomes w/ DAI
—path
—clinical presentation

Answer 14

PATH: Wallerian Degen, Dying back, axonal spheroids, demyelination, dendritic alterations esp in WM of:
—corpus callosum
—walls of 3rd ventricle
—dorsolateral b.s. & periaqueductal grey (b/c errything attached there)
CLIN: usu. LOC no lucid period —> PVS/coma —> death

Question 15

DAI Microscopic Time Course:

Answer 15

4-5 hrs: focal β-amyloid precursor protein (APP)
12-24 h: variscosities seen on H&E
24h - 2mo: axonal spheroids develop (will remain forever); microglial nodules
long-term: Wallerian degen, atrophy

Question 16

Signs of child abuse related head trauma on exam?

Answer 16

—retinal hemorrhages

—story inconsistent with physical exam