CNS Trauma

Question 1

What type of skull fracture usually occurs when the person is conscious?

Answer 1

Occipital

They fall back

Question 2

What type of skull fracture usually occurs when the person is unconscious?

Answer 2

Frontal

They fall forward

Question 3

What type of skull fractures are common after side impact and occipital trauma?

What is the result?

Answer 3

Skull base

Results:

• CSF or blook leakage from the nose/ears
• Hematomas on the face
• Cranial nerve deficits

Question 4

What is the result of sudden change in momentum of the head?

Answer 4

Concussion

Question 5

What are the symptoms of a concussion and what will accumulate that can histologically identify it?

Answer 5

• Instantaneous transient neurologic dysfunction
• Loss of consciousness
• Loss of reflexes
• Amnesia of event

Results in full nerologic recovery

Beta-amyloid precursor protein accumulates

Question 6

What is a contusion?

Answer 6

• Bruising resulting from transmission of force through other tissues (looks like wedge)
• Vessel injury, tissue damage, edema
• Crests of gyri
• Inferior surfaces of frontal lobe, temporal poles
• Anywhere adjacent to fractures (fracture contusion)

Question 7

What is a laceration?

Answer 7

Direct tearing of tissues by penetrating objects

Question 8

What is Coup vs. Contrcoup?

Answer 8

Coup lesion - At the site of the trauma, while the head is still

Contrecoup lesion - At the opposite site of the trauma, while the head is in motion

Question 9

What causes Diffuse Axonal Injury (DAI)?

Answer 9

• Angular acceleration
• Direct impact or contusion not necessary
• Results in axonal swellings and multifocal petechial hemorrhage and accumulation of Beta-APP

Question 10

What is an epidural hematoma and what is the cause?

Answer 10

• Hematoma above the dura (looks lens shaped)
• Middle meningeal arter tear by fracture
• Clinical presentation several hours after injury (lucid interval)

Question 11

What is a subdural hematoma and what is the cauase?

Answer 11

• Hematoma beneath the dura (looks crescent shaped)
• Bridging vein tear by sudden movement of brain
• Slowly progessive neurologic deterioration

Question 12

What is the zone of injury surrounding an area of complete infarction called?

Answer 12

Penumbra

Question 13

What are the characteristics of penumbra?

Answer 13

• Partial ischemia and reperfusion
• Delayed cell death vs. viability with or without altered cellular structure or function
• Secondary damage due to inflammation
• Potentially pharmacologically salvageable.

Question 14

What causes subarachnoid hemorrhages?

Answer 14

• Rupture of a berry (saccular) aneurysm
• “Worst headache of my life”