CNS Trauma

Question 1

Secondary CNS injury mechanisms includes the activation of the coagulation cascade, with VEGF release, which has this effect on vascular permeability

Answer 1

Increased

Question 2

In cerebral edema, neuronal death causes cell fragmentation/dissolution, leading to areas of this

Answer 2

Hyperosmolarity

Question 3

Mass effect of hematoma expansion includes these 2 things

Answer 3

Induced ischemia and Vasogenic edema

Question 4

In cerebral edema, what leads to areas of hyperosmolarity?

Answer 4

Neuronal death that causes cell fragmentation/dissolution

Question 5

Injury due to trauma/shaking with temporary impairment but no focal findings
Due to neuronal stretching and injury
Clinical: headache, confusion, loss of consciousness, dizzy, no measurable residual defect

Answer 5

Concussion

Question 6

Concussion injures this part of neurons

Answer 6

Axons

Question 7

Diffuse pattern of neuronal traumatic injury with axonal shearing
Requires large amount of force, often rotational force
Result is shearing or twisting of axons

Answer 7

Diffuse axonal injury

Question 8

Most diffuse axonal injuries occur in these brain regions

Answer 8

White matter tracts
(corpus callosum, brain stem, CB peduncles)

Question 9

Large amount of force, especially rotational force, can cause this type of neuronal injury

Answer 9

Diffuse axonal injury
(shearing or twisting of axons)

Question 10

Is there loss of consciousness with concussion?

Answer 10

Yes

Question 11

Is there loss of consciousness with diffuse axonal injury?

Answer 11

Immediate loss or decreased consciousness

Question 12

With this CNS injury, imaging shows only focal small hemorrhages and edema, especially in the corpus callosum and midbrain

Answer 12

Diffuse axonal injury

Question 13

Severe diffuse axonal injury leads to this

Answer 13

Death or permanent vegetative state

Question 14

Milder diffuse axonal injury leads to this

Answer 14

Cognitive or physical disability

Question 15

At 24 hours with this CNS injury, you begin to see axonal swelling and retraction bulbs

Answer 15

Diffuse axonal injury

Question 16

Retraction bulbs (swollen endings at the tips of injured axons) are seen morphologically 24 hours after this CNS injury

Answer 16

Diffuse axonal injury

Question 17

Is gliosis seen in diffuse axonal injury?

Answer 17

Yes, if the patient survives

Question 18

Neurodegenerative disorder due to repetitive head trauma (seen in athletes, military, abuse victims)

Answer 18

Chronic traumatic encephalopathy

Question 19

Chronic traumatic encephalopathy is also known as this

Answer 19

Dementia pugilistica

Question 20

Dementia pugilistica is another name for this condition

Answer 20

Chronic traumatic encephalopathy

Question 21

Neurofibrillary tangles are seen in this condition

Answer 21

Chronic traumatic encephalopathy

Question 22

Neurofibrillary tangles are seen in Chronic traumatic encephalopathy, due to this protein becoming abnormally phosphorylated

Answer 22

Tau protein

Question 23

In Chronic traumatic encephalopathy, abnormally phosphorylated tau protein forms this

Answer 23

Neurofibrillary tangles

Question 24

In Chronic traumatic encephalopathy, phosphorylated tau proteins (and neurofibrillary tangles) interfere with this function and transport
May be directly toxic and result in neuronal death

Answer 24

Microtubule

Question 25

Perivascular neuronal/astrocytic accumulation of Phospho-tau is seen in this condition

Answer 25

Chronic traumatic encephalopathy

Question 26

Phosphorylated tau proteins are found at depths of sulci in Chronic traumatic encephalopathy with this relation to vasculature

Answer 26

Perivascular

Question 27

This condition is IHC positive for phosphoryalted Tau protein

Answer 27

Chronic traumatic encephalopathy

Question 28

This CNS injury can cause mood disorders, suicidal ideation, cognition/memory problems, pyramidal defects, and dysarthria

Answer 28

Chronic traumatic encephalopathy

Question 29

This is a "bruise" of the brain

Answer 29

Cerebral contusion

Question 30

Cerebral contusion is most common at these locations of the brain

Answer 30

Bony prominences of frontal and temporal bones

Question 31

Cerebral contusion is most common at bony prominences of these 2 bones

Answer 31

Frontal and temporal bones

Question 32

This describes a cerebral contusion that occurs on the side of trauma impact

Answer 32

Coup lesion

Question 33

This describes a cerebral contusion that occurs on the side opposite of trauma impact

Answer 33

Contrecoup lesion

Question 34

Morphologically, cerebral contusions occur here

Answer 34

At top of gyri

Question 35

Hemorrhage, necrosis and edema are seen morphologically early or late after cerebral contusion?

Answer 35

Early

Question 36

Hemosiderin and gliosis are seen morphologically early or late after cerebral contusion?

Answer 36

Late (brown, depressed soft lesions; siderophages; reactive astrocytes; loss of neuropil)

Question 37

This type of skull fracture is a fracture through suture line

Answer 37

Diastatic fracture

Question 38

This type of skull fracture may result in leptomeningeal cyst and suture line separation

Answer 38

Diastatic fracture

Question 39

This type of skull fracture often does not require intervention

Answer 39

Simple linear non-depressed fracture

Question 40

A basilar skull fracture to this compartment can cause CSF rhinorrhea and raccoon eyes

Answer 40

Anterior

Question 41

A basilar skull fracture to this compartment can cause Battle sign (bruising behind the ear), CSF otorrhea, and hemotypamun

Answer 41

Posterior

Question 42

This protein is found in CNS, and can be detected in CSF rhinorrhea that occurs from anterior basilar skull fracture

Answer 42

Beta-2 transferrin

Question 43

Beta-2 transferrin is found in this

Answer 43

CSF

Question 44

A patient with raccoon eyes may have had this type of CNS injury

Answer 44

Basilar skull fracture (anterior)

Question 45

A patient with bruising behind their ear and blood in their ear cavity may have had this type of CNS injury

Answer 45

Basilar skull fracture (posterior)

Question 46

Do basilar skull fractures have good outcomes?

Answer 46

No; relatively poor outcomes

Question 47

How does perinatal brain injury correlate with gestational age?

Answer 47

Increases inversely with gestational age

Question 48

Subependymal periventricular zone of tissue with stem cells and immature glial tissue Loose vasculature without supporting basement membrane or vascular media Vulnerable to high pressure or hypoxic states

Answer 48

Germinal matrix

Question 49

The germinal matrix is located near this, in inferior wall of lateral ventricles

Answer 49

Thalamus

Question 50

Germinal matrix is located near the thalamus, in the inferior wall of this

Answer 50

Lateral ventricles

Question 51

Germinal matrix is prominent at this gestational time; regresses in infancy

Answer 51

2nd / 3rd trimester

Question 52

Is germinal matrix hemorrhage usually serious?

Answer 52

Usually clinically silent (may produce sudden deterioration if large enough - decerebrate posturing, stupor, apnea)

Question 53

Aqueductal stenosis, subarachnoid obliteration, and periventricular white matter degeneration are possible sequelae of this condition

Answer 53

Germinal matrix hemorrhage

Question 54

Germinal matrix hemorrhage may cause the obliteration of this

Answer 54

Subarachnoid

Question 55

Group of permanent disorders of movement due to non-progressive disturbances of developing brain

Answer 55

Cerebral palsy

Question 56

Is cognition affected in cerebral palsy?

Answer 56

Often not affected

Question 57

Are patients with cerebral palsy born with a complicated labor and delivery?

Answer 57

No (Most born with uncomplicated labor and delivery)

Question 58

Does perventricular leukomalacia, a lesion that can cause cerebral palsy, have symmetric or focal clinical findings?

Answer 58

Symmetric (e.g. spastic di/quadriplegia)