19.11 Flashcards
Concussion refers to the instantaneous loss of ___, temporary ___ arrest and loss of reflexes.
Loss of consciousness
Temporary respiratory arrest
The ___ ___ scale is used for clinical assessment of head injuries.
Glasgow coma scale
CNS injury is the highest cause of death in people
45
There are 3 types of skull fractures: ___, ___ and ___
Open - communication with surface.
Closed - no communication with surface.
Comminuted - splintering of bone.
Extradural haematomas are often due to bleeding of the ___ ___ artery, usually due to ___ of the skull.
Middle meningeal artery
Fractures
In an extradural haemorrhage, there is an ___ bleed, that is rapid and can cause an increase in ___ ___.
Arterial bleed!
Increase in intracranial pressure.
In older people, an extradural haemorrhage is ___ likely, and is ___ common in young people. Why?
LESS likely! More common in young people.
The dura increases adherence to the skull over ageing so it is less likely for blood to dissect in potential space.
Subdural haematomas are due to ___ bleeds - these can be acute or chronic, and are relatively ___ compared to extradural bleeds.
Venous bleeds
Slow - oozing of veins.
In older people, a subdural haemorrhage is ___ likely. Why?
MORE likely!
The brain shrinks over ageing so the subdural veins are on slight tension/stretch and are more likely to rupture on minor impact.
What are the sites of contusions (haemorrhagic necrosis/bruises)?
Coup - at impact site.
Contrecoup - if head is not fixed on impact, injury to opposite side of impact.
Stereotypic contusions often at base of brain e.g. inferior frontal lobes and inferolateral temporal lobes.
Brain injury is commonly associated with some ___ haemorrhage.
Subarachnoid
In old cerebral contusions, tissue ___ due to action of macrophages, and you can see ___-stained areas of depressed brain tissue.
Shrinks
Haemosiderin-stained areas
In the brain, there is usually no repair by fibrosis, but repair is by ___
Gliosis!
Tissue is gliotic.
What are the forms of diffuse brain injury?
Traumatic/diffuse axonal injury (TAI/DAI) i.e. of white matter.
Diffuse vascular injury.
When axons are acutely damaged, ___ continues to flow from the neuron and pools before the site of injury.
Axoplasm
Using IHC, you can see deposition of ___ ___ protein - an early effect of diffuse brain injury.
Alzheimer/amyloid precursor protien
What are the long term effects of diffuse axonal injury?
Enlarged lateral ventricles and third ventricle, enlarged temporal horns of lateral ventricles.
Gliosis due to uptake of injured tissues by macrophages.
Gliosis is a tissue ___ process.
Losing
In diffuse axonal injury, the cortex/grey matter is ___
Preserved/normal
If ICP increases to arterial pressure, then ___ perfusion stops.
Brain
What are the two main types of cerebral oedema?
Vasogenic and cytotoxic
Vasogenic cerebral oedema is due to disruption of the ___ with ___ vascular permeability.
Disruption of the BBB with increased vascular permeability.
Cytotoxic cerebral oedema is due to increased ___ fluid secondary to neuronal, glial or endothelial cell membrane injury.
Intracellular fluid
Vasogenic cerebral oedema mainly affects the ___ matter and is ___ responsive.
White matter
Steroid responsive
Cytotoxic cerebral oedema affects ___ and ___ matter and is not ___ responsive.
Grey and white matter
NOT steroid responsive
CSF is produced in the ___ ___, and approx. ___ is produced per day.
Choroid plexus
400 mL
CSF circulates to the ___ aspect of the brain and drains into ___ ___
Superior
Arachnoid granulations
Duret haemorrhages are ___ haemorrhages - why do they occur?
Brainstem haemorrhages!
The blood supply of the brainstem (from basilar artery) is fixed so when the brainstem moves down e.g. due to diencephalic herniation the brainstem vessels can tear and haemorrhage.
