Exam 3: Head Injuries

Question 1

scalp

Answer 1

hair
skin
superficial fascia layer
epicranius muscle
deep fascia layer
periosteum

Question 2

cranium

Answer 2

supports and protects brain

Question 3

meninges

Answer 3

three membranes that envelop brain and spinal cord:

1. dura mater - outer
2. arachnoid - middle
3. pia mater - inner

Question 4

subarachnoid space

Answer 4

between arachnoid and pia mater - contains csf

Question 5

contrecoup injury

Answer 5

opposite hit injury - i.e. frontal hit with damage to cerebellum

Question 6

major brain arteries

Answer 6

1. internal carotid arteries - anterior brain
2. vertebral arteries - posterior brain
3. circle of willis - formed by connection of internal carotid and vertebral - ensures continuous blood supply if one or other is damaged
4. external carotid arteries - scalp and neck

Question 7

circle of willis

Answer 7

formed by connection of internal carotid and vertebral arteries
- ensures continuous blood supply if one is damaged

Question 8

major veins

Answer 8

1. internal jugular vein - anterior
2. vertebral veins - posterior
3. external jugular - scalp and cranium

Question 9

3 major brain injury classifications

Answer 9

1. skull fracture
2. focal injuries
3. diffuse injury

Question 10

brain injury - skull fracture

Answer 10

with or without damage to intracranial structures:

brain, meninges, arteries, veins

Question 11

brain injury - focal injury

Answer 11

localized area of the brain has been contused - internal bleeding - 50% of all injuries - most deaths

1. epidural/extradural hematoma
2. subdural hematoma

Question 12

brain injury - diffuse injury

Answer 12

causes wide spread disruption of neural activity - 40% of all hospitalizations - 35% of all head injury deaths
1. cerebral concussion

Question 13

epidural/extradural hematoma (focal)

Answer 13

• results in arterial bleeding
• occurs fast
• occurs under high pressure
• can cause serious brain injury quickly (minutes)

Question 14

pathology of epidural/extradural hematoma

Answer 14

1. injury to one or more of the meningeal arteries
2. meningeal arteries supply blood to the dura mater and brain
3. meningeal arteries are located in boy grooves in the skull

Question 15

What area of the brain is damaged in an epidural/extradural hematoma?

Answer 15

meningeal arteries - supply blood to dura mater and brain

Question 16

What is the MOI for an epidural/extradural hematoma?

Answer 16

1. blow to the head
2. head hits an object
3. indirect force

Question 17

Diagnostic tests for epi/extradural hematoma

Answer 17

• X-rays
• mri
• ct scan

Question 18

signs and symptoms of hematoma

Answer 18

1. loss of consciousness at time of injury
2. recovery of consciousness in variable period of time
3. patient is lucid
4. onset of increasingly severe headache - ER IMMEDIATELY
5. decreased level of consciousness
6. dilation of pupil - usually same side as clot
7. weakness - usually on opposite side of clot
8. decerebrate posturing

Question 19

Hematoma

Answer 19

localized collection of blood outside the blood vessel

Question 20

Subdural hematoma (focal)

Answer 20

1. frequently involves damage to a subdural vein
2. collection of blood in subdural space
3. often associated with swelling of brain
4. occurs more frequently (3:1) than epidural hematomas

Question 21

signs and symptoms of subdural hematoma

Answer 21

1. same as epidural/extradural with one exception:

- symptoms may appear rapidly as in an epidural or may take hours, days, or weeks

Question 22

ipsilateral

Answer 22

occurring on same side

Question 23

signs and symptoms of expanding lesion

Answer 23

1. severe headache - increases - most important
2. visual disturbance
3. nausea or vomiting
4. increase in dizziness
5. inability to concentrate
6. tinnitis
7. weakness
8. pupil change in size
9. convulsions
10. blood or csf drainage from ears or nose
11. slurred speech
12. increased drowsiness
13. difficulty in rousing patient
14. marked slowness of pulse
15. stiff neck
16. pulsating pain in eye
17. unconsciousness

Question 24

What is a concussion?

Answer 24

severe shaking or violent jarring of the brain

Question 25

MOI for concussions - Knock-out state

Answer 25

1. disruption in the electrochemical activity of the brain 2. possibly from anoxia 3. caused by constriction of blood vessels

Question 26

Concussion scenarios

Answer 26

1. conscious & ambulatory 2. conscious & non-ambulatory 3. unconscious

Question 27

concussion severity

Answer 27

1. length of unconsciousness | 2. length signs and symptoms persist

Question 28

amnesia

Answer 28

1. anterograde (post traumatic) - inability to recall events that have occurred from the moment of injury 2. retrograde - inability to recall events prior to injury

Question 29

Second impact syndrome

Answer 29

1. may occur if the athlete is returned to competition before all cerebral functions have cleared 2. re-injury - chance of death or vegetative state is approx 50% with almost a sure chance of permanent injury 3. most commonly occurs in football