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Signs and symptoms of raised ICP

Generalised Seizures
Mental changes
Plateau waves


Structures injured in severe Cx flexion (hyperflexion) whiplash injury?

IVD rupture
Cervical vertebral body compression
Articular facet fracture
Vertebral body dislocation
Dislocation of facets (because they are more horizontal, more likely to dislocate)
SP avulsion fracture
Posterior muscles
o Traps, lev scap more commoly than deep
o ES
o Splenius capitius, cervicus

Can also injure:
Ligamentum flavum
Interspinous ligaments
Ligamentum nuchae

Forceful flexion commonly produces crush or compression fracture of vertebral body. This may be associated with anterior movement of the vertebral body with dislocation. Articular facets may be fractured or dislocated with rupture of interspinous ligaments.


Which structures are injured in a whiplash injury during the hyperextension component?

Crush the vertebral arch or cause hangman’s fracture or may rupture the ALL or anulus of the disc

Anterior structures:
Forceful extension may crush the vertebral arch or cause hangman’s fracture or may rupture the ALL or anulus of the disc.

Osephagus and trachea (even as deep as carotids and jugular, sympathetic trunk).

Neural: Cervical plexus first, lateral movement= brachial plexus. Can also have injury to vagus and phrenic nerve.


If there was a bleed in the brain - which CN would you test and why? How would this CN present if bleed was present?

- CN exam: Due to the location of CN III and the long pathway of CN IV, these CN's are most likely to show early ssx of increased intracranial pressure.
(would present in the eyes)?????

You would carry out a vitals exam and then a CN exam.
- Vitals examination: as compression of the brainstem can cause increase BP, resp rate and a decrease in heart rate.(?)


Discuss the path if the oculomotor nerve - origin and exiting?



Discuss the path of the abducens nerve



What structures can encroach on an IVF?

osteophytes, fractures ???


What structures travel through the IVF?

mixed nerve root and corresponding arterial supply


What is the function of the ophthalmic division of the trigeminal nerve?

sensory to the CNV1 division of the face (forehead)


List the bones that make up the cranium (vault/neurocranium) and the face (viscerocranium)

4 single bones
- Frontal
- Occipital
- Sphenoid
- Ethmoid

2 paired bones:
- temporal x 2
- parietal x 2

Single bones:

Pairs of bones:
Inferior Nasal Conchae


What makes up the circle of willis?

Vertebral arteries form the basilar.

The basilar artery enters the Circle of Willis with the Internal carotid arteries. These then anastomose and branch to form the Middle, Anterior and Posterior cerebral arteries.

Vertebral arteries enter the skull by traversing the transverse foramina between C6 and C3, then enters the skull via the foramen magnum.

The internal carotid artery enters the skull by entering the carotid canal of the temporal bone, and then exits the temporal bone through the carotid canal

In the case of gradual arterial obstruction, the circle of Willis is an important source of collateral blood supply to the superficial aspect of the cerebrum.

Limitations are that this doesn't help blockages in the end branches of these arteries


What are the signs of a bleed on the brain in an adult due to blunt trauma of the head?

Compressive injury, as blunt trauma to the skull can cause a skull fracture which could lead to a epidural haemotoma, which would cause compression of underlying brain substance.

He might get local compression of the brain tissue directly under the haemotoma, causing focal ssx.

He might get false localising symptoms from the compression causing the brain to shift and press against the opposite side of the brain cavity.

He might get herniation of the brain tissue as its pushed across the dural folds.