CNS Trauma - Fractures

Question 1

What are three common types of CNS trauma?

Answer 1

• Skull Fractures
• Parenchymal injuries
• Traumatic vascular injury

Question 2

What are three common parenchymal injuries?

Answer 2

• Concussion
• Direct parenchymal injury
• Diffuse axonal injury

Question 3

What are three common traumatic vascular injuries?

Answer 3

• Epidural hematoma
• Subdural hematoma
• Subarachnoid hemorrhage

Question 4

What are the four types of skull fractures?

Answer 4

• Linear
• Depressed
• Diastatic
• Basal

Question 5

What is a linear fracture?

Answer 5

• Most common
• Straight crack
• Usually not serious

Question 6

What is a depressed fracture?

Answer 6

• Bone displaced inward
• Comminuted (in pieces)
• Can damage brain

Question 7

What is a diastatic fracture?

Answer 7

• Across a suture
• Suture widens
• Usually in children

Question 8

What is a basal fracture?

Answer 8

• More force
• Distant hematomas
• CSF drainage
• Battle sign -hematoma that usually appears behind ear -possible indicator of basal skull fracture
• Also bruising around eyes - another sign of basal skull fracture

Question 9

What is a concussion?

Answer 9

Def: Altered consciousness from head injury due to change in momentum of head (head hits rigid surface)

• It’s a stretching/snapping back of the brain that causes the most damage (like snapping a beach ball). The compression and stretching seems to contribute to concussion
• Mechanism unknown
• Symptoms: amnesia, confusion, headache, visual disturbances, nausea, vomiting, dizziness

Question 10

What is Second-Impact Syndrome?

Answer 10

• Second concussion occurs before the first one heals
• Brain swells rapidly, catastrophically
• Due to inability of arterioles to regulate diameter?
• Young athletes are at the greatest risk
• Derek Boogard who died at age 28

Question 11

What is chronic traumatic encephalopathy?

Answer 11

• Progressive degenerative disease of the brain
• Athletes/other with repetitive brain trauma
• Behavioral/personality symptoms:
• -poor judgement
• -apathy
• -depression
• -memory loss
• -confusion
• -aggression
• Then, progressive dementia
• Histologically looks like Alzheimer disease

Question 12

What are tau protein deposits?

Answer 12

• It is a protein that accumulates in the brain of alzheimer’s disease
• It is NOT accumulated as a result of normal aging
• NFL linebacker and Champion boxer had severe dementia and tau in the brain
• Tau deposits also found in brain of 18 year old football player

Question 13

What is this:

• Laceration (tearing of tissue)
• Contusion (bruising)
• Blows can result in
• -Coup injury (contusion (breaking of blood vessels) at point of contact)
• -Contrecoup injury (contusion on opposite side)

Answer 13

Direct Parenchymal Injury:

Parenchymal -bulk/functional parts of organ

Question 14

How are coup and contra coup injuries different than concussions?

Answer 14

• They are not a concussion because you can locate the injury in the brain - more sever than a concussion, its a blow to the head

Question 15

What is this:

• Injury of axons in deep white matter of brain
• Twisting/shearing of axons
• Caused by angular acceleration/deceleration
• “Shaken baby” syndrome, boxing
• Common cause of persistent deficits or coma after trauma

Answer 15

Diffuse Axonal Injury

Question 16

What does diffuse axonal injury show in autopsy?

Answer 16

• May show punctate hemoherrage
• May also see axonal spheroids as a result of trauma
• Result of twisting, shearing - little pink dots - AXONAL SPHEROIDS

Question 17

What happens in an epidural hematoma?

Answer 17

• Blood above dura
• Usually a tear in middle meningeal artery
• Typical setting: hit in temple with baseball (middle meningeal artery is below)
• May have lucid period (oh that really hurt but I’m okay)
• Neurosurgical emergency
• Contours will be smooth on MRI

Question 18

What happens in a subdural hematoma?

Answer 18

• Blood between the dura and arachnoid
• Shearing of bridging veins
• Typical setting: elderly patient falls, seems okay (can still happening younger patients too)
• Acute (hours) or chronic (months)
• Not necessarily surgical emergency but may need surgery
• MRI doesn’t show smooth contours

Question 19

What happens in a subarachnoid hemorrhage?

Answer 19

• Sometimes its traumatic, but often not
• Blood in subarachnoid space (when they rupture)
• Contusions, berry aneurysms
• Typical setting: “worst headache I ever had” - first thing you should think of on an exam or with a patient
• Doesn’t collect in mass like it does in other hematoma
• Neurosurgical emergency

Question 20

How are ruptured aneurysms treated now?

Answer 20

Inserting coils through femoral arteries (instead of opening head). Then pass in tiny platinum coils and cut them and leave them there. You form a clot and leave them there. This gives strength and prevent the aneurism from blowing open.