CNS Trauma - Fractures Flashcards
What are three common types of CNS trauma?
- Skull Fractures
- Parenchymal injuries
- Traumatic vascular injury
What are three common parenchymal injuries?
- Concussion
- Direct parenchymal injury
- Diffuse axonal injury
What are three common traumatic vascular injuries?
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hemorrhage
What are the four types of skull fractures?
- Linear
- Depressed
- Diastatic
- Basal
What is a linear fracture?
- Most common
- Straight crack
- Usually not serious
What is a depressed fracture?
- Bone displaced inward
- Comminuted (in pieces)
- Can damage brain
What is a diastatic fracture?
- Across a suture
- Suture widens
- Usually in children
What is a basal fracture?
- More force
- Distant hematomas
- CSF drainage
- Battle sign -hematoma that usually appears behind ear -possible indicator of basal skull fracture
- Also bruising around eyes - another sign of basal skull fracture
What is a concussion?
Def: Altered consciousness from head injury due to change in momentum of head (head hits rigid surface)
- It’s a stretching/snapping back of the brain that causes the most damage (like snapping a beach ball). The compression and stretching seems to contribute to concussion
- Mechanism unknown
- Symptoms: amnesia, confusion, headache, visual disturbances, nausea, vomiting, dizziness
What is Second-Impact Syndrome?
- Second concussion occurs before the first one heals
- Brain swells rapidly, catastrophically
- Due to inability of arterioles to regulate diameter?
- Young athletes are at the greatest risk
- Derek Boogard who died at age 28
What is chronic traumatic encephalopathy?
- Progressive degenerative disease of the brain
- Athletes/other with repetitive brain trauma
- Behavioral/personality symptoms:
- -poor judgement
- -apathy
- -depression
- -memory loss
- -confusion
- -aggression
- Then, progressive dementia
- Histologically looks like Alzheimer disease
What are tau protein deposits?
- It is a protein that accumulates in the brain of alzheimer’s disease
- It is NOT accumulated as a result of normal aging
- NFL linebacker and Champion boxer had severe dementia and tau in the brain
- Tau deposits also found in brain of 18 year old football player
What is this:
- Laceration (tearing of tissue)
- Contusion (bruising)
- Blows can result in
- -Coup injury (contusion (breaking of blood vessels) at point of contact)
- -Contrecoup injury (contusion on opposite side)
Direct Parenchymal Injury:
Parenchymal -bulk/functional parts of organ
How are coup and contra coup injuries different than concussions?
- They are not a concussion because you can locate the injury in the brain - more sever than a concussion, its a blow to the head
What is this:
- Injury of axons in deep white matter of brain
- Twisting/shearing of axons
- Caused by angular acceleration/deceleration
- “Shaken baby” syndrome, boxing
- Common cause of persistent deficits or coma after trauma
Diffuse Axonal Injury
What does diffuse axonal injury show in autopsy?
- May show punctate hemoherrage
- May also see axonal spheroids as a result of trauma
- Result of twisting, shearing - little pink dots - AXONAL SPHEROIDS
What happens in an epidural hematoma?
- Blood above dura
- Usually a tear in middle meningeal artery
- Typical setting: hit in temple with baseball (middle meningeal artery is below)
- May have lucid period (oh that really hurt but I’m okay)
- Neurosurgical emergency
- Contours will be smooth on MRI
What happens in a subdural hematoma?
- Blood between the dura and arachnoid
- Shearing of bridging veins
- Typical setting: elderly patient falls, seems okay (can still happening younger patients too)
- Acute (hours) or chronic (months)
- Not necessarily surgical emergency but may need surgery
- MRI doesn’t show smooth contours
What happens in a subarachnoid hemorrhage?
- Sometimes its traumatic, but often not
- Blood in subarachnoid space (when they rupture)
- Contusions, berry aneurysms
- Typical setting: “worst headache I ever had” - first thing you should think of on an exam or with a patient
- Doesn’t collect in mass like it does in other hematoma
- Neurosurgical emergency
How are ruptured aneurysms treated now?
Inserting coils through femoral arteries (instead of opening head). Then pass in tiny platinum coils and cut them and leave them there. You form a clot and leave them there. This gives strength and prevent the aneurism from blowing open.
