Flashcards in Brain Trauma Deck (13):
Blunt head injury
The most common general type of brain injury and can result in damage to bones, parenchyma or blood vessels, singly or in combination.
* linear (radiating from site of impact)
* basal (involves bones of skull base)
* depressed (bone pushed into cranial cavity)
* contrecoup (fracture occurs at distance from point of injury, e.g, occipital blow ---> orbital roof fracture)
fracture associated with laceration of scalp is compound, with laceration of dura is open (penetrating)
consequences of skull fracture include intracranial hematoma, CSF leak through ear (otorrhea) or nose (rhinorrhea), damage to cranial nerves, and ingress of air (pneumocephalus) or infectious agents.
hemorrhage within the superficial brain tissue without disruption of pia-arachnoid at brain surface
a. coup vs. contrecoup (underlying impact site vs. opposite side of brain)
b. usually occurs at crests of gyri in frontal and temporal poles, orbitofrontal and lateral temporal
c. may be relatively asymptomatic but later glial scarring can lead to development of seizures.
traumatic disruption of the surface of the brain with hemorrhage.
Coup contre-coup injuries
Coup represents lesions underlying the site of impact and contre-coup lesions diagonally opposite. If the head is the moving object (impacting on pavement): contre-coup > coup, and if the head is hit by a moving object: coup > contre-coup
Diffuse axonal injury
Where is it seen
disruption of axons, particularly of long tracts in the brain stem (especially midbrain), corpus callosum, deep cerebral white matter
Diffuse axonal injury
common in severer rotation/acceleration injuries (e.g., whiplash).
pathology: perivascular microhemorrhages with formation of swollen axons (spheroids), which accumulate β-APP
Level of consciousness/milder form
patients with severe DAI are unconscious from moment of injury; may remain comatose, vegetative or severely disabled for life.
concussion (transient loss of consciousness) and sequelae probably represent mild form of DAI.
Traumatic subarachnoid hemorrhages
Occur along with…
Parenchymal or vascular lacerations
Diffuse vascular injury
Occurs as a consequence of…
Shearing BV’s and axons (DAI) w/in the brain parenchyma due to severe shear/rotation forces