19.11

Question 1

Concussion refers to the instantaneous loss of ___, temporary ___ arrest and loss of reflexes.

Answer 1

Loss of consciousness

Temporary respiratory arrest

Question 2

The ___ ___ scale is used for clinical assessment of head injuries.

Answer 2

Glasgow coma scale

Question 3

CNS injury is the highest cause of death in people

Answer 3

45

Question 4

There are 3 types of skull fractures: ___, ___ and ___

Answer 4

Open - communication with surface.
Closed - no communication with surface.
Comminuted - splintering of bone.

Question 5

Extradural haematomas are often due to bleeding of the ___ ___ artery, usually due to ___ of the skull.

Answer 5

Middle meningeal artery

Fractures

Question 6

In an extradural haemorrhage, there is an ___ bleed, that is rapid and can cause an increase in ___ ___.

Answer 6

Arterial bleed!

Increase in intracranial pressure.

Question 7

In older people, an extradural haemorrhage is ___ likely, and is ___ common in young people. Why?

Answer 7

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.

Question 8

Subdural haematomas are due to ___ bleeds - these can be acute or chronic, and are relatively ___ compared to extradural bleeds.

Answer 8

Venous bleeds

Slow - oozing of veins.

Question 9

In older people, a subdural haemorrhage is ___ likely. Why?

Answer 9

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.

Question 10

What are the sites of contusions (haemorrhagic necrosis/bruises)?

Answer 10

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.

Question 11

Brain injury is commonly associated with some ___ haemorrhage.

Answer 11

Subarachnoid

Question 12

In old cerebral contusions, tissue ___ due to action of macrophages, and you can see ___-stained areas of depressed brain tissue.

Answer 12

Shrinks

Haemosiderin-stained areas

Question 13

In the brain, there is usually no repair by fibrosis, but repair is by ___

Answer 13

Gliosis!

Tissue is gliotic.

Question 14

What are the forms of diffuse brain injury?

Answer 14

Traumatic/diffuse axonal injury (TAI/DAI) i.e. of white matter.
Diffuse vascular injury.

Question 15

When axons are acutely damaged, ___ continues to flow from the neuron and pools before the site of injury.

Answer 15

Axoplasm

Question 16

Using IHC, you can see deposition of ___ ___ protein - an early effect of diffuse brain injury.

Answer 16

Alzheimer/amyloid precursor protien

Question 17

What are the long term effects of diffuse axonal injury?

Answer 17

Enlarged lateral ventricles and third ventricle, enlarged temporal horns of lateral ventricles.
Gliosis due to uptake of injured tissues by macrophages.

Question 18

Gliosis is a tissue ___ process.

Answer 18

Losing

Question 19

In diffuse axonal injury, the cortex/grey matter is ___

Answer 19

Preserved/normal

Question 20

If ICP increases to arterial pressure, then ___ perfusion stops.

Answer 20

Brain

Question 21

What are the two main types of cerebral oedema?

Answer 21

Vasogenic and cytotoxic

Question 22

Vasogenic cerebral oedema is due to disruption of the ___ with ___ vascular permeability.

Answer 22

Disruption of the BBB with increased vascular permeability.

Question 23

Cytotoxic cerebral oedema is due to increased ___ fluid secondary to neuronal, glial or endothelial cell membrane injury.

Answer 23

Intracellular fluid

Question 24

Vasogenic cerebral oedema mainly affects the ___ matter and is ___ responsive.

Answer 24

White matter

Steroid responsive

Question 25

Cytotoxic cerebral oedema affects ___ and ___ matter and is not ___ responsive.

Answer 25

Grey and white matter

NOT steroid responsive

Question 26

CSF is produced in the ___ ___, and approx. ___ is produced per day.

Answer 26

Choroid plexus

400 mL

Question 27

CSF circulates to the ___ aspect of the brain and drains into ___ ___

Answer 27

Superior

Arachnoid granulations

Question 28

Duret haemorrhages are ___ haemorrhages - why do they occur?

Answer 28

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.