Traumatic Head/Spinal Injury

Question 1

2 kinds of skull fractures

Answer 1

linear

depressed

Question 2

concussion is defined as?

Answer 2

clinical term
instantaneous loss of consciousness
temp resp arrest
loss of reflexes

Question 3

pathogenesis of concussion?

Answer 3

maybe brainstem?

Question 4

percentage of CNS injury:
all deaths
deaths from trauma
deaths from MVAs?

Answer 4

1% all deaths
30% deaths from trauma
50% deaths from MVAs?

Question 5

what is penetrating injury?

Answer 5

direct disruption of tissue

Question 6

what is a closed injury?

Answer 6

movement and compression of brain within skull

Question 7

2 acute secondary effects of traumatic head injury?

Answer 7

ischemia

hypoxia

Question 8

3 delayed secondary effects of traumatic head injury?

Answer 8

increased ICP
infection
epilepsy

Question 9

difference between open and closed fracture of skull?

Answer 9

open communicates with outside world, increase risk of infection

Question 10

splintering of bone?

Answer 10

comminuted

Question 11

when do you get blood/csf from nose/ears?

Answer 11

basal fracture

Question 12

cause of epidural hematomas? more likely in what age group?

Answer 12

middle meningeal artery

younger age group

Question 13

cause of subdural hematomas? more likely in what age group?

Answer 13

subdural veins, acute or chronic

older ppl more likely, brain shrinkage

Question 14

what is brain contusion?

Answer 14

hemorrhagic necrosis bruising

Question 15

what is coup?

Answer 15

site of impact

Question 16

what is contrecoup?

Answer 16

opposite site of impact

Question 17

where do sterotypic contusions occur?

Answer 17

base of brain, inferior frontal and temporal lobes

Question 18

what does an old cerebral contusion look like macroscopically?

Answer 18

collapsed brain tissue
orange staining
scarring at tips of gyri

Question 19

what is a vulnerable site if too much energy transfer?

Answer 19

ponto-medullary junction

Question 20

What is particularly vulnerable to TAI/DAI?

Answer 20

corpus callosum

Question 21

what is diffuse axonal injury?

Answer 21

diffuse vascular injury, usually secondary

Question 22

what is a histological sign of diffuse axonal injury?

Answer 22

axonal spheroids: build up of proteins in broken axons

Question 23

longterm effects of diffuse axonal injury includes?

Answer 23

brain atrophy
enlarged ventricles
thin corpus callosum
less white matter

Question 24

what happens to spinal cord in vertebral # and dislocation?

Answer 24

cord compression, toothpaste effect

Question 25

4 longer term sequelae of brain trauma?

Answer 25

infections hydrocephalus ( blocked 4th ventricle exits) epilepsy chronic traumatic encephalopathy

Question 26

chronic traumatic encephalopathy features? 3

Answer 26

brai atrophy abnormal Tau protein deposition A/B plaque deposition

Question 27

how much blood and CSF in brain?

Answer 27

150ml each

Question 28

how does blood and CSF react initially to trauma?

Answer 28

drainage of both as much as possible, then increase ICP (explains delay)

Question 29

when do you get zero brain perfusion?

Answer 29

as ICP approaches arterial pressure

Question 30

what happens to brain tissue close to dural openings?

Answer 30

herniations

Question 31

big causes of raised ICP? 5 things

Answer 31

``` cerebral oedema trauma hemorrhage infection too much or blocked exit of CSF ```

Question 32

2 subtypes of cerebral oedema

Answer 32

vasogenic: white matter BBB more permeable cytotoxic: white and grey matter, increased INTRAcellular fluid.

Question 33

which cerebral oedema is responsive to steroids?

Answer 33

vasogenic | NOT cytotoxic