CNS Trauma (Macroscopic Responses) (finished)

Question 1

Describe the four main types of skull fractures

Answer 1

Linear

• Most common
• Straight crack
• Usually not serious

Depressed

• Bone displaced inward
• Comminuted (in pieces)
• Can damage brain

Diastatic

• Across a suture
• Suture widens
• Usually in children

Basal

• More force
• Distant hematomas
• CSF drainage

Question 2

list a few signs that a patient with a basal skull fracture might exhibit

Answer 2

battle sign, leaking CSF fluid

Question 3

Define concussion and describe some of its clinical symptoms and sequelae

Answer 3

Definition: Altered consciousness from head injury due to change in momentum of head (head hits rigid surface)

Mechanism unknown

Symptoms: amnesia, confusion, headache, visual disturbances, nausea, vomiting, dizziness

Grading:
Grade 1: no loss of consciousness, lasts 15 minutes
Grade 3: LOC

Question 4

Describe a typical clinical setting for the development of each of the following:
epidural hematoma

Answer 4

Blood above dura
Tear in middle meningeal artery
Typical setting: hit in temple with baseball
May have lucid period
Neurosurgical emergency

Question 5

Describe a typical clinical setting for the development of each of the following:
subdural hematoma

Answer 5

Blood between dura and arachnoid
Shearing of bridging veins
Typical setting: elderly patient falls, seems okay
Acute (hours) or chronic (months)

Question 6

Describe a typical clinical setting for the development of each of the following:
subarachnoid hemorrhage

Answer 6

Blood in subarachnoid space
Contusions, ruptured berry aneurysms
Typical setting: “Worst headache I ever had”
Neurosurgical emergency

Question 7

Describe a typical clinical setting for the development of each of the following:
diffuse axonal injury

Answer 7

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
axonal spheroids common

Question 8

Second-Impact Syndrome

Answer 8

Second concussion before first one healed
Brain swells rapidly, catastrophically
Due to inability of arterioles to regulate diameter?
Young athletes at greatest risk

Question 9

Chronic Traumatic Encephalopathy

Answer 9

Progressive degenerative disease of the brain
Athletes/others with repetitive brain trauma
Behavioral/personality symptoms:
-poor judgment
-apathy
-depression
-memory loss
-confusion
-aggression
Then, progressive dementia
Histologically looks like Alzheimer disease

Question 10

Direct Parenchymal Injury

Answer 10

Laceration (tearing of tissue)
Contusion (bruising)
Blows can result in:
-Coup injury (contusion at point of contact)
-Contrecoup injury (contusion on opposite side)