18. Pathophys of Traumatic Head Injuries

Question 1

External head injuries that are located at the level of the hat rim line are indicative of what? Below this line?

Answer 1

A fall Below, indicative of injury inflicted on victim

Question 2

How does a laceration from a fall appear?

Answer 2

Wide-shaped margins, abrasions, tissue bridging. Occurs at bony prominence

Question 3

What is raccoon’s eyes?

Answer 3

Bilateral periorbital ecchymosis

Question 4

What are terminal fall injuries due to?

Answer 4

Loss of consciousness

Question 5

Which kind of injuries typically appear in a linear pattern?

Answer 5

Terminal fall injuries

Question 6

Will punching a person in the face typically cause a fracture?

Answer 6

No. Not enough force usually

Question 7

Five classifications of facial fractures

Answer 7

Dentoalveolar fracture LeFort I fracture LeFort II fracture LeFort III fracture Sagittal Fracture

Question 8

What is a dentoalveolar fracture?

Answer 8

Separation of a fragment of the mandible that includes teeth

Question 9

Answer 9

LeFort Fractures

Question 10

Sagittal Fracture

Answer 10

Runs through the sagital plane, passing through the maxilla

Question 11

What is a subgaleal hematoma

Answer 11

Hemorrhage that occurs beneath the galea aponeurotica, a group of tendons that spans the cranium connecting the frontalis and occipitalis muscles

Question 12

Epidural Hematoma

Answer 12

Arterial bleed of MMA or venous sinus, superficial to the dura

Question 13

EDH effect on cortex

Answer 13

Flattens the cortex

Question 14

EDH occurs rapidly or slowly? What is the significance of this?

Answer 14

Rapidly –> increased pressure on cortex –> altered mental status

Question 15

What is so important to remember about an EDH hematoma?

Answer 15

Hematoma has sequestered blood that doesn’t interact with blood circulation –> allows blood content to remain present in hemorrhage –> can test for alcohol, drugs, etc.

Question 16

What is a SDH?

Answer 16

Tearing of bridging veins that link superficial cortical veins to the superior sagittal sinus

Question 17

SDH effect on cortex

Answer 17

No real effect, cortex is still undulating even though it is compressed. Can become flattened overtime

Question 18

What can we see with a chronic SDH

Answer 18

Will see a fibrous membrane –> sign of child abuse

Question 19

Subarachnoid hemorrhage (SAH) results from what?

Answer 19

Hemorrhage between the arachnoid and pia. Results from drugs, natural, or trauma

Question 20

Natural cause of SAH, and which drugs cause SAH?

Answer 20

Natural cause: berry aneurysm

Drugs: Cocaine and amphetamines

Question 21

Dstatic skull fracture

Answer 21

Sawtooth appearance, seen in children with unfused skull bones

Question 22

Basilar fracture is associated with what sign? Where are basilar fractures occur?

Answer 22

Associated with Battle Sign: bruising over the mastoid process

Basilar fractures: fractures on the base of skull

Question 23

Hinge fracture

Answer 23

Fatal

Extends from one side of skull to another side

Question 24

Ring fracture

Answer 24

Around the foramen magna; caused from jumping from high height. Brain basically impaled by vertebra

Question 25

Coup, contra-coup, intermediary coup contusions

Answer 25

Coup contusion: contusion resulting from a stationary head being struck by a moving object. Contusion is on side of impact Contra-coup contusion: contusion resulting from a moving had hitting a stationary object. Contusion is on contralateral side of impact Intermediary Coup contusion: contusion resulting from rotationary movement of head. Has aspects of both coup and contra-coup

Question 26

Name the kinds of traumatic brain injuries

Answer 26

Concussion, Diffusion axonal injury

Question 27

Concussion and its symptoms

Answer 27

Functional damage is present, but no damage to axons is noticed Symptoms: Headache, n/v

Question 28

Difference between concussion and diffusion axonal injury

Answer 28

In concussions, we see no structural damage to the axons. In diffusion axonal injury, we see structural damage to axons

Question 29

Diffusion axonal injury effects, where is the injury most often seen

Answer 29

Oftentimes due to brain moving side-to-side More severe, leads to memory and motor problems, personality disorders, and impaired cognitive ability Seen in white matter tracts (high density of axons), including corpus callosum, internal capsule, cerebral peduncles

Question 30

What would the presence of BAPP indicate?

Answer 30

Beta amyloid precursor protein - indicates axonal damage noticed with diffusion axonal injury

Question 31

Shaken Baby Syndrome. What damage is noted?

Answer 31

Result of rapid acceleration or deceleration multiple times No distinct impact sites Sub-dural hematoma and brain swelling, cervical cord injury, retinal and optic n. injury