Chapter 1: Trauma Overview

Question 1

Traumatic brain injury can be divided chronologically and pathoetiologically into _____ and _____ injury.

Answer 1

Primary and secondary injuries

Question 2

This type of injuries occur at the time of initial trauma.

Skull fractures, epi- and subdural hematomas, contusion, axonal injury, and brain lacerations are examples.

Answer 2

Primary injuries

Question 3

These injuries occur later and include cerebral edema, perfusion alterations, brain herniation, and CSF leaks.

Answer 3

Secondary injuries

Although vascular injury can be immediate (blunt impact) or secondary (vessel laceration from fractures, occlusion secondary to brain herniation), for purposes of discussion, it is included on secondary injuries.

Question 4

The goal of emergent neuroimaging is twofold, which are?

Answer 4

1. Identify treatable injuries, especially emergent ones

2. Detect and delineate the presence of secondary injuries, such as herniation syndromes and vascular injury.

Question 5

What is the role of skull radiography in trauma?

Answer 5

Between one-quarter and one-third of autopsied patients with fatal brain injuries have no identifiable skull fracture!

Therefore, skull radiography obtained solely for the purpose of identifying the presence of a skull fracture has NO appropriate role in the current management of the head-injured patient..

Question 6

What is the reason why CT is now the accepted worldwide screening tool for imaging acute head trauma?

Answer 6

CT depicts both bone and soft tissue injuries. It is widely accessible, fast, effective, and comparatively inexpensive.

Question 7

When is craniocervical CT angiography considered?

Answer 7

1. In the setting of penetrating neck injury
2. if a fracture foramen transversarium or facet subluxation is identified on cervical spine CT
3. If a skull base fracture traverses the carotid canal or a dural venous sinus.

Arterial laceration or dissection, traumatic pseudoaneurysm, carotid-cavernous fistutal, or dural venous sinus injury are nicely depicted on high-resolution CTA.

Question 8

NECT is the procedure of choice in the initial evaluation of brain trauma. What are the limitations of MR?

Answer 8

Limitations of MR include acquisition time, access, patient monitoring and instability, motion degradation of images, and cost.

Question 9

What is the one important exception for using MR as routine screening procedure in the setting of acute brain trauma?

Answer 9

Suspected child abuse

Standard MR together with susceptibility-weighted imaging and DTI is most useful in the subacute and chronic stages of TBI.