18. Pathophys of Traumatic Head Injuries Flashcards
External head injuries that are located at the level of the hat rim line are indicative of what? Below this line?
A fall Below, indicative of injury inflicted on victim
How does a laceration from a fall appear?
Wide-shaped margins, abrasions, tissue bridging. Occurs at bony prominence
What is raccoon’s eyes?
Bilateral periorbital ecchymosis
What are terminal fall injuries due to?
Loss of consciousness
Which kind of injuries typically appear in a linear pattern?
Terminal fall injuries
Will punching a person in the face typically cause a fracture?
No. Not enough force usually
Five classifications of facial fractures
Dentoalveolar fracture LeFort I fracture LeFort II fracture LeFort III fracture Sagittal Fracture
What is a dentoalveolar fracture?
Separation of a fragment of the mandible that includes teeth
LeFort Fractures
Sagittal Fracture
Runs through the sagital plane, passing through the maxilla
What is a subgaleal hematoma
Hemorrhage that occurs beneath the galea aponeurotica, a group of tendons that spans the cranium connecting the frontalis and occipitalis muscles
Epidural Hematoma
Arterial bleed of MMA or venous sinus, superficial to the dura
EDH effect on cortex
Flattens the cortex
EDH occurs rapidly or slowly? What is the significance of this?
Rapidly –> increased pressure on cortex –> altered mental status
What is so important to remember about an EDH hematoma?
Hematoma has sequestered blood that doesn’t interact with blood circulation –> allows blood content to remain present in hemorrhage –> can test for alcohol, drugs, etc.
What is a SDH?
Tearing of bridging veins that link superficial cortical veins to the superior sagittal sinus
SDH effect on cortex
No real effect, cortex is still undulating even though it is compressed. Can become flattened overtime
What can we see with a chronic SDH
Will see a fibrous membrane –> sign of child abuse
Subarachnoid hemorrhage (SAH) results from what?
Hemorrhage between the arachnoid and pia. Results from drugs, natural, or trauma
Natural cause of SAH, and which drugs cause SAH?
Natural cause: berry aneurysm
Drugs: Cocaine and amphetamines
Dstatic skull fracture
Sawtooth appearance, seen in children with unfused skull bones
Basilar fracture is associated with what sign? Where are basilar fractures occur?
Associated with Battle Sign: bruising over the mastoid process
Basilar fractures: fractures on the base of skull
Hinge fracture
Fatal
Extends from one side of skull to another side
Ring fracture
Around the foramen magna; caused from jumping from high height. Brain basically impaled by vertebra
Coup, contra-coup, intermediary coup contusions
Coup contusion: contusion resulting from a stationary head being struck by a moving object. Contusion is on side of impact
Contra-coup contusion: contusion resulting from a moving had hitting a stationary object. Contusion is on contralateral side of impact
Intermediary Coup contusion: contusion resulting from rotationary movement of head. Has aspects of both coup and contra-coup
Name the kinds of traumatic brain injuries
Concussion, Diffusion axonal injury
Concussion and its symptoms
Functional damage is present, but no damage to axons is noticed
Symptoms: Headache, n/v
Difference between concussion and diffusion axonal injury
In concussions, we see no structural damage to the axons. In diffusion axonal injury, we see structural damage to axons
Diffusion axonal injury effects, where is the injury most often seen
Oftentimes due to brain moving side-to-side
More severe, leads to memory and motor problems, personality disorders, and impaired cognitive ability
Seen in white matter tracts (high density of axons), including corpus callosum, internal capsule, cerebral peduncles
What would the presence of BAPP indicate?
Beta amyloid precursor protein - indicates axonal damage noticed with diffusion axonal injury
Shaken Baby Syndrome. What damage is noted?
Result of rapid acceleration or deceleration multiple times
No distinct impact sites
Sub-dural hematoma and brain swelling, cervical cord injury, retinal and optic n. injury
