Pathology of Head Injury

Question 1

What are the five basic injury types to the skin

Answer 1

Bruises - blunt force damages little blood vessels in adjacent skin

Abrasions/grazes - injuries to the superficial part of the skin

Lacerations - tears in the skin due to blunt force injuries (splits at weakest part)

Incisions - Cutting to the skin caused by sharp force energies

Thermal injuries

Question 2

What is the different types of skull fractures

Answer 2

Ring fracture

Fissure fracture

Depressed fracture

Hairline fracture

Question 3

What occurs in a ring fracture

Answer 3

Considerable energy is put into the skull from one point of impact the fracture spreads out and forms a ring and will often take in foramen magnum and if sufficient energy cause diastasis of the sutures

Question 4

What occurs in a fissure fracture

Answer 4

Lesser energy is put into the skull from one point of impact (blunt force) but isn’t enough energy to go all the way around and complete a ring

Question 5

What happens to cause either a ring or fissure fracture

Answer 5

Big force over a wide area is applied over the head

Question 6

What occurs in a depressed fracture

Answer 6

is a break in a cranial bone with depression of the bone in toward the brain.

Question 7

What happens to cause a depressed fracture

Answer 7

Localised blunt force applied to the head/skull

Question 8

When would a hairline fracture require treatment in aid to prevent what?

Answer 8

If open, and causes infection via emissary veins leading to meningitis

Question 9

What skull fracture has the least energy input

Answer 9

Hairline fracture

Question 10

What is the three different intracranial haemorrhages

Answer 10

Extradural - blood accumulating between skull and dura

Sub dural - blood accumulating between dura and arachnoid

Subarachnoid - blood accumulation between arachnoid and pia

Question 11

What is a common cause of extradural haemorrhage

Answer 11

Skull fraction damages the middle meningeal artery and leads to blood accumulation outside the dura matter and increases arterial pressure

Question 12

What is the location of the middle meningeal artery

Answer 12

The middle meningeal artery runs through the foramen spinosum, underneath the temporal bone at the side of the head, and above the dura mater, a layer of protective brain tissue.

Question 13

What is the signs of extradural haemorrhage

Answer 13

Unconsciousness

If don’t fall unconscious can later lead to death due to undiagnosed haemorrhage

Question 14

What is the common cause of sub dural haemorrhage

Answer 14

Occurs as the brain moves in relation to dura of the skull,

The head hits a wall, and the brain momentums acceleration causes the
veins that submerse the dura space to move in different directions, which stretches and tear they leading to haemorrhage as they burst

Question 15

Where is it common to see people lucid with chronic subdural heamatoma

Answer 15

elderly

alcoholic

Question 16

How does a traumatic subarachnoid haemorrhage usual occur

Answer 16

Due to a traumatic injury e.g. being struck on the neck or a blow to the chin damaging the vertebral artery in the neck and causing a basal subarachnoid haemorrhage

Question 17

How does a spontaneous subarachnoid haemorrhage occur

Answer 17

Ruptured cerebral aneurysm

Ateriovenous malformation - abnormal tangle of arteries and veins with no capillaries in between, the weakened vessels can rupture

Question 18

What is the complications of subarachnoid haemorrhage

Answer 18

The blood vessel near aneurysm going into vasospasm (if cerebellar artery spasms can cause global hypoxic brain damage)

Stroke - area of brain that previously received oxygen from the affected artery is now deprived of oxygen in the blood

Increased pressure -Blood in the cerebrospinal fluid (CSF)

Pool/clot of Blood can irritate, damage, or destroy nearby brain cells

Hydrocephalus - Blood from a torn aneurysm can block CSF circulation

Question 19

What is the symptoms of subarachnoid haemorrhage

Answer 19

Sudden onset
Thunder clap headache

Dizziness- leads to collapse

Photophobia

Nausea and vomiting

Stiff neck

blurred or double vision

loss of consciousness

seizures

Question 20

What does subarachnoid haemorrhage focus on

Answer 20

stopping the bleeding, restoring normal blood flow, and preventing vasospasm.

Question 21

How is subarachnoid haemorrhage managed

Answer 21

Surgical clipping to aneurysm/ ruptured vessel

Pain medication - alleviate headache

Anticonvulsants - prevents or treat seizures

Question 22

How is the symptoms of subarachnoid haemorrhage managed

Answer 22

Pain medication will be given to alleviate headache

Anticonvulsant medication may be given to prevent or treat seizures

Question 23

What are the surgical treatment for subarachnoid haemorrhage

Answer 23

Surgical clipping

Endovascular coiling

Question 24

What occurs in surgical clipping

Answer 24

an opening in the skull (craniotomy) is made to locate the aneurysm. A small titanium clip is placed across the neck of the aneurysm to stop blood flow from entering.

Question 25

What occurs in endovascular coiling

Answer 25

a catheter is inserted into an artery in the groin during an angiogram. The catheter is advanced through the blood stream to the aneurysm. Platinum coils or liquid glue (Onyx) are packed into the aneurysm to stop blood flow from entering.

Question 26

What is the three types of intracerebral haemorhage

Answer 26

Cortical contusion

Intracerebral haemorrhage

Diffuse axonal injury

Question 27

What causes cortical contusion

Answer 27

Brain momentum is different from the skulls momentum so in either acceleration or a quick deceleration the brain moves along skull base and strikes it causing bruising of the brain

or
Direct force can cause contusion on the surface of the brain

Question 28

Where does a coup injury occur

Answer 28

where the direct blow occurs to the head there will be a contusion there as energy is transmitted through skin and scalp to the brain area affected

Question 29

Where does a countercoup injury occur

Answer 29

Occurs at the frontal/temporal pole (on the side opposite the area that was hit)

Question 30

When does a coup injury occur

Answer 30

When a moving object impacts the stationary head, coup injuries are typical

Question 31

When does a contrecoup injury occur

Answer 31

while contrecoup injuries are produced when the moving head strikes a stationary object

Question 32

What occurs in an intracerebral haemorrhage

Answer 32

A haemorrhage within the brain itself

Question 33

What occurs in a blunt trauma if the petrous temporal bone is affected

Answer 33

Basal fracture - can affect cranial nerves and pituitary fossa

Question 34

What is the two causes of intra-cerebral haemorrhages

Answer 34

Natural disease

Traumatic

Question 35

What are examples of natural diseases causing intracerebral haemorrhage

Answer 35

Hypertensive

AV anomaly

Amyloid angiopathy (delicate susceptible vessels)

Vascular tumours

Question 36

How does a traumatic intracerebral haemorrhage arise

Answer 36

Where you have vulnerable vessels - that respond unusually to energy that is transmitted during head injury and cause a massive zone of disruption bleeding into the brain

Question 37

What occurs in a diffuse axonal injury

Answer 37

Occurs where you have big acceleration and deceleration injuries to the brain which causes a rotation
resulting in diffuse disruption to neurones

Question 38

Where does a diffuse axonal injury occur

Answer 38

Deep within, white matter, basal ganglia

Question 39

What is the fate of diffuse axonal injury

Answer 39

Death instantaneously

Declared brain dead