Pathophysiology of Traumatic Head Injury & Herniation Syndromes

Question 1

An 8-month-old baby is autopsied. The corner notes optic nerve sheath hemorrhage. The police want to know if foul play was involved. How should the corner respond?

Answer 1

Possibly - optic nerve sheath hemorrhage is very indicative of rapid acceleration/deceleration. This may be a result of shaken baby syndrome

Question 2

This type of skull fracture is most associated with jumping from a building.

Answer 2

Ring fracture - fracture around foramen magnum. These are generally fatal

Question 3

What is a cingulate gyrus herniation?

Answer 3

Expansion of the cerebral hemisphere that displaces the cingulate gyrus

Question 4

In a head injury, an injury to the brain that occurs under the site of impact is termed…?

Answer 4

Coup injury

Question 5

What is a coup injury?

Answer 5

A cerebral contusion under the site of a head injury

Question 6

This hematoma is most often arterial in nature, commonly involving the middle meningeal artery.

Answer 6

Epidural hematoma - more rapid blood accumulation due to arterial origin

Question 7

This type of injury generally appears in a linear pattern due to being hit with a blunt object.

Answer 7

Contusion

Question 8

This type of facial fracture causes separation of a part of the mandible and often contains teeth.

Answer 8

Dentoalveolar fracture

Question 9

A patient experiences head trauma. The radiology report describes a pear-shaped hemorrhage. What kind of hemorrhage is this?

Answer 9

Epidural hemorrhage

Question 10

A sagittal fracture through the maxilla is what type of fracture?

Answer 10

Sagittal fracture

Question 11

How does a coup injury differ from a counter-coup injury?

Answer 11

A coup injury occurs on the brain under the site of impact. A counter-coup injury occurs on the side of the brain opposite the site of impact

Question 12

A hemorrhage just below the scalp is termed? This type of hemorrhage may be difficult to diagnose clinically.

Answer 12

Subgaleal hematoma

Question 13

This hematoma is most often venous in nature and has a higher survival rate due to slower blood accumulation.

Answer 13

Subdural hematoma

Question 14

Simply put, how do LeFORT I-III fractures differ?

Answer 14

Fractures ascend more cranially from LeFORT fracture I to III

Question 15

This type of injury is due to wearing or rubbing away by friction.

Answer 15

Laceration

Question 16

True/False. Structural damage will be noted on imaging following a concussion.

Answer 16

False. There is functional damage, but no structural damage that will appear on imaging.

Question 17

An 80yo woman experiences a syncope episode at home, falls forward, and experiences various trauma to the face. The patient is later found deceased by a loved one. What is the probable cause of death?

Answer 17

Terminal fall injury - often due to loss of consciousness and injury to the bony prominences of the face

Question 18

A high transverse fracture involving the maxilla that passes through the medial orbital wall is what type of head fracture?

Answer 18

LeFORT III

Question 19

A fracture of the maxilla above the apices of the teeth through the nasal septum and maxillary sinuses is what type of head fracture?

Answer 19

LeFORT I

Question 20

A patient experiences head trauma. The radiology report describes a crescent-shaped hemorrhage. What kind of hemorrhage is this?

Answer 20

Subdural hemorrhage

Question 21

Diffuse axonal injuries present in the white matter of the brain. Where are DAIs most commonly found?

Answer 21

Midline and paramedian structures (corpus callosum, internal capsule, cerebral peduncles) that absorb the most force following impacts

Question 22

What is a LeFORT II fracture?

Answer 22

Pyramidal fracture that curves near the zygomatic-maxillary suture and through the orbital floor

Question 23

What is a diastatic fracture?

Answer 23

Fracture with sawtooth appearance, often found in younger persons with sutures that have not fully formed

Question 24

What morphologic changes present with chronic cerebral edema?

Answer 24

Flattening of gyri and narrowing of sulci

Question 25

What are the types of facial fractures?

Answer 25

Dentoalveolar, LeFORT I, LeFORT II, LeFORT III, Sagital

Question 26

Pupillary dilation may be indicative of what type of brain herniation?

Answer 26

Transtentorial herniation - the temporal lobe is compressed under the tentorium, compressing CN III

Question 27

These types of hematomas are most often associated with tramua.

Answer 27

Subdural and epidural hematomas

Question 28

What are common causes of a subarachnoid hematoma?

Answer 28

Rupture aneurysm, trauma (vertebral artery trauma), drugs

Question 29

Axonal swelling and beta-amyloid precursor proteins are hallmark findings of what type of brain injury?

Answer 29

Diffuse Axonal Injuries

Question 30

What type of brain herniation is the most severe?

Answer 30

Tonsilar herniation due to brainstem compression

Question 31

How does a laceration differ from a cut?

Answer 31

A laceration occurs when a blunt object tears the skin. The edges are not smooth and size and shape of the wound varies depending on the object

Question 32

This type of skull fracture leads to fragments that injure the brain.

Answer 32

Depressed fracture