What is the most common type of skull fracture? What's the treatment?
linear - just a straight crack in the head
not serious - usually heals on its own
Describe a depressed skull fracture?
This is when the bone is displaced inward - usually with a comminuted fracture
this can damage the brain, but often heals on its own
What is a diastatic fracture? Who gets them most often?
It's a fracture across a suture, making the suture widen
usually in children
What is a basal skull fracture?
A fracture at the base of the skull
Usually takes a lot of force for this to happen
can be difficult to diagnose because you can't really see it based on outward appearance
What clinical signs should you look for if concerned about a basal fracure?
Look for distant hematomas = Battle sign behind the ear or raccoon's eyes
CSF draining form the nose or ears
blood from the ears
What's the definition of a concussion?
altered consciousness from head injury due to change in moment of the head
What is the grading system for concussions?
grade 1: no LOC, confusion lasts less then 15 minutes
Grade 2: no LOC, confusion lasts over 15 minutes
Grade 3: LOC
What is the major concern about an athlete going back to playing before a 1st concussion is fully healed?
second impact syndrome
this is a second consussion before the first one is healed - the brain swells rapidly, causing death
likely has to do with dysfunction of arteriole blood flow regulation
fortunately its rare
What is chronic traumatic encephalopathy
a progressive degenerative disease of the brain associated with repetitive brain trauma
What are some symptoms of CTE?
poor judgement, apathy, personaly changes, depression, memory loss, confusion, aggression, ultimately progressive dementia
What other neurodegenerative disease does CTE mirror?
Alzheimers - looks very similar histologically and anatomically - you get a buildup of tau protein in both
What are direct parenchymal injuries?
injuries to the substance of the brain itself - lacerations, contusions, bullet wounds, etc.
What is the difference between Coup injury and a contrecoup injury? Which is worse
Coup - contusion at the point of contact with the skull
contrecoup - contusion on the opposite side
contrecoup is usually worse becaue it tends to strike there twice - once immediately at the injury and then again on the rebound
What happens to axons in diffuse axonal injury?
the axons are twisted and sheared during angular acceleration/deceleration - like in boxers and shaken baby syndrome
How can you tell axonal shearing has occured on gross anatomy?
You'll see pinpoint hemorrhages
What will you see histologically in diffuse axonal injury?
What are the three main traumatic vascular injuries to know?
Describe an epidural hematoma.
It's blood above the dura- usually from a tear in middle meningeal artery from getting hit in the temple
they may have a lucid period before deteriorating!!!!
This is a neurosurgical emergency
What will an epidural hematoma look like on imaging?
it will have smooth contours because the dura is super thick and tough
Describe a subdural hematoma.
It's blood between the dura and arachnoid
from shearing of the cerebral bridging veins -
typically in elderly patients who fall and seem okay until symptoms develop hours or months later
What will a subdural hematoma look like on imaging?
It will have ragged contours
Describe a subarachnoid hemorrhage.
It's blood in the subarachnoid space from rupture of a cerebral artery - often from rupture of a berry aneurysm
"worse headache I ever had"
In general, where do berry aneurysms typically develop?
branching points in the circle of willis
What is the treatment for berry aneurysms?
you threat a wire up through the femoral artery and maneuver it into a coiled knot within the aneurysm and leave it in - this causes the immune system to clot aroudn that area.