Pathology of head injury

Question 1

cOOMON CAUSES OF HEAD INJURY

Answer 1

RTA/trauma

Question 2

What is the primary insult? What would b the secondry insuls?

Answer 2

Primary = the actual brain trauma

Secondary insult = things that can happen outside of brain as a result
-hypotension
-hypoxia
-infection
-haematoma

Question 3

GCS scale severity : mild/moderate/severe

Answer 3

Mild = 13-15
Moderate = 9-13
Severe = coma = 3-8

Question 4

What is enceohalitis?

Answer 4

infection of the brain itself, so like meningitis is infection and inflammation of the meninges, encephalitis is of the brain

Question 5

P in SCALP

Answer 5

Periosteum

Question 6

In what meinges can blood vessels be found?

Answer 6

in Arachnoid mater

Question 7

WHich meninges are “stuck” together?

Answer 7

Dura and arachnoid

Question 8

Why do we get a lot of lacerations on head?

Answer 8

because not much scope for movement, so skin tears easily, often in clean lines

Question 9

Laceration vs inscised

Answer 9

laceration = from tearing

Incised = from sharp injury

Question 10

What is a hinge fracture?

Answer 10

A linear fracture (commonly temporo-parietal) that continues to the skull base

Question 11

What type of fractures cause infection

Answer 11

Depressed fracture, because the bone is broken it is a easy route in for pathogens.

Also risk of post traumatic epilepsy

Question 12

What is a ring fracture? What can cause it?

Answer 12

A fracture around the foramen magnum

Often due to sudden decellaration injuries, eg fall from height and landing on feet. due to brainstem impact on the base of hte skull

Question 13

What is a contra- oup fractue?

Answer 13

When the back of the head is hit, but it is the front of the skull that fractures (thinner)

Question 14

What is coning?

Answer 14

Raised ICP forcing the brianstem out of the skull through the foramen magnum.

Question 15

Msot common cause of extradural haemorrhage?

Answer 15

MMA (middle meningeal) artery

Question 16

Subdural commonly caused by which veins shear and tear? Who seen in most and why?

Answer 16

Bridging veins.

Rotational/”shearing” force can cause veins to stretch and tear.

More common in alcoholics and elderly as brian shrinks and so the veins already might be stretched to a degree.

Question 17

Can Sub dural be mistaken fro dementia?

Answer 17

Yes, if occurs in eldery, because it can stop bleeding and because of the shrunken brain, it has the space to occupy but still cause neuronal damage.

Question 18

Extradural vs sub dural lucid intervals

Answer 18

Extradural is much shorter because it is an artery and so pumping more blood, so dramatic downturn is very fast.

Subdural is longer because it comes from veins.

Question 19

Sub arachnoid haemorrhage, SAH most common cause? In trauma also due to what?

Answer 19

Berry Aneurysms.

In trauma seen with BRUISING, and too fast movement from side to side, causeing shearing of the vertibro-basillar artery, but the reason death is so quick os because of shearing of the brainstem (we think)

Question 20

What are contusions?

Answer 20

Direct mechanical damage to brain

Question 21

contracoup injuries

Answer 21

Damage on Opposite side to impact

Question 22

What is Traumatic diffuse axonal injury?

Answer 22

Caused by vigourous shaking kinda, although not only caused by trauma. Axonal injury all around the brain.

Question 23

What might you see to indicate diffuse axonal injury? Where are the more likely to appear (axonal injury)

Answer 23

In the blood vessles, - diffuse vascular injury would point you i the right direction.

Most likely to appear in corpus callosum, para-saggital white matter, internal capsule and dorsolateral aspects of brainstem and cerebellar peduncles.

Question 24

In fatalietits, what is often the common cause of death?

Answer 24

Raised ICP causing compression of the brainstem and tonsils andd eventual vital functions from the brainstem are cut off.