Traumatic brain injury

Question 1

Periorbital ecchymosis, CSF rhinorrhea, and pain after fall on the back of the head

Answer 1

Contrecoup anterior basal skull fracture

Question 2

Ecchymosis over mastoids, hemotympanum, and CSF otorrhea after trauma

Answer 2

Petrous bone fracture

Question 3

Head is immobile at time of trauma

Answer 3

Coup injury

Question 4

Head is mobile at time of trauma

Answer 4

Both coup and contrecoup may be seen

Question 5

Focal necrosis and hemorrhage over the crest of gyri

Answer 5

Contusion

Question 6

Interruption of white matter tracts due to high-speed deceleration, usually with immediate LOC

Answer 6

Diffuse axonal injury (DAI)

Question 7

MRI findings in DAI

Answer 7

Axonal damage at gray-white junction
Hemosiderin deposits

Question 8

Accumulation of axon transported proteins within axonal swellings at the point of injury leading to axonal bulb formation

Answer 8

Diffuse axonal injury (DAI)

Question 9

Axon transported proteins accumulated in DAI

Answer 9

Alpha-synuclein
Amyloid precursor

Question 10

Clinical syndrome of briefly lost consciousness after a minor head injury, often with brief amnesiac period, without evidence of structural cerebral injury

Answer 10

Concussion

Question 11

Moving head is suddenly arrested by impact on rigid surface causing dysregulation of reticular activating system in brain

Answer 11

Concussion

Question 12

Hemorrhage within the potential space between the inner table of the skull an outer periosteal layer

Answer 12

Epidural hemorrhage

Question 13

Most common epidural hemorrhage

Answer 13

Laceration of middle meningeal A, associated with temporal bone fracture

Question 14

CT shows hyperdense, biconvex, lentiform, extra-axial mass confined by cranial sutures

Answer 14

Epidural hemorrhage

Question 15

Hemorrhage from shearing of bridging veins

Answer 15

Acute subdural hemorrhage

Question 16

CT shows hyperdense, extra-axial, biconcave, crescent-shaped mass that crosses the cranial sutures, but not dural reflection with mass effect.

Answer 16

Acute subdural hemorrhage

Question 17

More common in elderly due to underlying brain atrophy and accentuated subdural space, even in the absence of trauma

Answer 17

Chronic subdural hemorrhage

Question 18

CT shows low density or mixed density, biconcave mass with mass effect.

Answer 18

Chronic subdural hemorrhage

Question 19

Whiplash action of infants head, often accompanied by posterior rib fractures and retinal hemorrhage

Answer 19

Shaken baby syndrome or abusive head trauma

Question 20

Sudden onset of severe HA from disruption of small vessels on brain surface, often with rapid neurologic deterioration

Answer 20

Subarachnoid hemorrhage

Question 21

Xanthochromia

Answer 21

Blood mixes with CSF

Question 22

CT shows high density blood in the sulci

Answer 22

Subarachnoid hemorrhage

Question 23

Progressive neurodegenerative process caused by repeated closed-head injuries

Answer 23

Chronic traumatic encephalopathy (CTE)

Question 24

Reactive gliosis and redistribution of aquaporin 4 molecules, Tau-positive neurofibrillary tangles, and TDP-43 binding protein in subcortical and perivascular regions

Answer 24

Chronic traumatic encephalopathy

Question 25

Most important secondary processes in traumatic brain injury

Answer 25

Cerebral edema
Increased ICP