Brain Trauma

Question 1

Blunt head injury

incidence

Answer 1

The most common general type of brain injury and can result in damage to bones, parenchyma or blood vessels, singly or in combination.

Question 2

Skull fracture

types

Answer 2

• linear (radiating from site of impact)
• basal (involves bones of skull base)
• depressed (bone pushed into cranial cavity)
• contrecoup (fracture occurs at distance from point of injury, e.g, occipital blow —> orbital roof fracture)

Question 3

Skull fracture

Assoc with…/consequences

Answer 3

fracture associated with laceration of scalp is compound, with laceration of dura is open (penetrating)

consequences of skull fracture include intracranial hematoma, CSF leak through ear (otorrhea) or nose (rhinorrhea), damage to cranial nerves, and ingress of air (pneumocephalus) or infectious agents.

Question 4

Contusion

def

Answer 4

hemorrhage within the superficial brain tissue without disruption of pia-arachnoid at brain surface

Question 5

Contusion

Gen chars

Answer 5

a. coup vs. contrecoup (underlying impact site vs. opposite side of brain)
b. usually occurs at crests of gyri in frontal and temporal poles, orbitofrontal and lateral temporal
c. may be relatively asymptomatic but later glial scarring can lead to development of seizures.

Question 6

Laceration

def

Answer 6

traumatic disruption of the surface of the brain with hemorrhage.

Question 7

Coup contre-coup injuries

def

Answer 7

Coup represents lesions underlying the site of impact and contre-coup lesions diagonally opposite. If the head is the moving object (impacting on pavement): contre-coup > coup, and if the head is hit by a moving object: coup > contre-coup

Question 8

Diffuse axonal injury

Where is it seen

Answer 8

disruption of axons, particularly of long tracts in the brain stem (especially midbrain), corpus callosum, deep cerebral white matter

Question 9

Diffuse axonal injury

Seen in/pathology

Answer 9

common in severer rotation/acceleration injuries (e.g., whiplash).

pathology: perivascular microhemorrhages with formation of swollen axons (spheroids), which accumulate β-APP

Question 10

DAI

Level of consciousness/milder form

Answer 10

patients with severe DAI are unconscious from moment of injury; may remain comatose, vegetative or severely disabled for life.

concussion (transient loss of consciousness) and sequelae probably represent mild form of DAI.

Question 11

Traumatic subarachnoid hemorrhages

Occur along with…

Answer 11

Parenchymal or vascular lacerations

Question 12

Diffuse vascular injury

Occurs as a consequence of…

Answer 12

Shearing BV’s and axons (DAI) w/in the brain parenchyma due to severe shear/rotation forces

Question 13

Penetrating Head Injury

Most commonly gunshot wounds or penetration with sharp objects.

Answer 13

a. Gunshot wound; exit wound is larer and more lacerated than the entrance wound.
b. Penetration by high velocity bullets can give rise to extensive brain damage (brain stem) distant from entrance and exit wounds of the bullet.