3. Traumatic Brain and Spinal Injury Flashcards
Where are contrecoup injuries most commonly found?
Roof of orbits and cribiform plates
What are the signs of a base of the skull fracture?
Racoon eyes
Battle’s sign
CSF leak from nose and ears
Haemotypanium
What is meant by a burst lobe?
When haemorrhage from a laceration extends into the subarachnoid space
Why does it take 2 days for an intracerebral haemorrhage to evolve?
Blood vessels were not initially torn but break down after 2 days
Mannitol may have been given to treat ICP originally but increase risk of haemorrhage later on
What is the most common sequelae of brain injury?
Subarachnoid haemorrhage
What artery can be damaged by trauma to the neck?
Vertebral artery
What shape is a extradural haematoma?
Lemon-shaped as doesn’t cross suture lines
What is the most common cause of an extradural haematoma?
Skull fracture of the squamous temporal bone, severing the middle meningeal artery
What shape is a subdural haematoma?
Banana-shaped
What is an acute subdural haematoma?
Rupture of bridging veins after falls and assaults
What does the prognosis of a subdural haematoma depend on?
Extent of the contusions and swelling
The blood can be reabsorbed and resolve spontaneously
What is a chronic subdural haematoma?
Unrelated to acute
A trivial head injury evolves over weeks
Granulation tissue forms a membrane around haemorrhage, high risk of rebleeding as granulation vessels are weak
What is the biggest risk factor for a chronic subdural haematoma?
Anticoagulation
What are the risks for intracerebral haemorrhage?
Amyloid
Atherosclerosis
What type of force causes axonal injury?
Angular or rotational acceleration
What is the clinical course of a diffuse axonal injury?
Unconscious at impact and remain vegetative until death
Brain can look normal at autopsy or may show petechiae on corpus collosum and dorsal brainstem
What are the signs of diffuse axonal injury on histology?
Axonal swelling
Varicosities
‘Retraction’ bulbs
B-APP marker shows abnormal axonal flow
What areas in the brain are affected first by ischaemia?
Hippocampus
Deep grey structures
Watershed area in cortex
What can cause fracture or dislocation of the cord?
Hyperflexion/extension
Compressive forces
Rotational movements (dislocations)
What is Chronic Traumatic Encephalopathy?
brain atrophy and loss of neurons due to multiple mild brain injuries
Causes neuropsychiatric and movement disorders
How is a diagnosis of Chronic Traumatic Encephalopathy made at autopsy?
Aggregation of phosphorylated tau protein in astrocytes, neurons and cell processes
