Craniofacial trauma Flashcards
superior in the detection of acute epidural and subdural hematomas and non-hemorrhagic brain injury
MRI
more sensitive modality in brainstem injury and to subacute to chronic hemorrhage
MRI, especially with FLAIR, GRE and SWI
particularly sensitive in detection of blood products and can identify small areas of hemorrhage undetectable on GRE sequences or even CT
SWI
provides improved detection of both acute and chronic neuronal injury
DWI and DTI
most common manifestation of scalp injury and can be recognized on CT or MR as focal soft tissue swelling of scalp, located beneath the subcutaneous fibrofatty tissue and above the temporalis muscle and calvarium
subgaleal hematoma
isolated linear skull fractures are managed
do not require tx
management of depressed and compound skull fractures
surgical management
fractures of the temporal bone can be classified either according to the following
orientation relative to the long axis of petrous bone or according to their involvement of the otic capsule
if a temporal bone fracture parallels the long axis of the petrous pyramid, it is termed
“longitudinal” fracture
temporal fractures perpendicular to the long axis of the petrous bone are termed
transverse fractures
represents 70 to 90% of temporal bone fractures. it results from blow to the side of the head
longitudinal temporal bone fx
complications in longitudinal temporal bone fx
conductive hearing loss, dislocation or fx of the ossicels and CSF otorhinorrhea, delayed or incomplete facial nerve palsy
results from a blow to the occiput or frontal region
transverse temporal bone fracture
complications of transverse temporal bone fx
sensorineural hearing loss, severe vertigo, nystagmus and perilymphatic fistula, facial palsy in 30 to 50%, injury to carotid artery or jugular vein
fx that run anterolateral to the otic capsule and are usually caused by direct blows to the temporoparietal region
otic capsule- sparing fractures
fx wherein the cochlea and semicircular canals are damaged. these fx are the result of direct impacts to the occipital region
otic capsule- violating fx
complications of otic capsule-violating fx
facial nerve injury, CSF leak, hearing loss, intracranial injuries such as epidural hematoma and SAH
vessel origin of epidural hematomas
arterial, middle meningeal artery
skull fractures are seen in 85 - 95% of what extra-axial hemorrhage
epidural hge
common location of epidural hematomas
temporal or temporoparietal location
venous epidural hematomas are less common, tends to occur at what areas
vertex, posterior fossa, or anterior aspect of the middle cranial fossa
what collection can cross the falx cerebri
epidural
shape of epidural collection
lenticular or biconvex
extra-axial collection that does not cross cranial sutures, where the periosteal layer of the dura is firmly attached. Near the vertex however, the periosteum forms the outer wall of the sagittal sinus and is less tightly adherent to the sagittal suture. therefore, in this region, this extra-axial collection can cross midline
epidural
subdural hemorrhages are typically what vessel of origin
venous, cortical veins, may also result form disruption of penetrating branches of superficial cerebral arteries
subdural hematoma typically extends over a much larger area that epidural hematoma because
the inner dural layer and arachnoid are not as firmly attached as the structures that make up the epidural space
subdural hematomas commonly present after what type of injury
acute deceleration injury from MVA or fall
brain injury freq seen with acute subdural hematomas
cortical contusions and DAI
shape of subdural collection
crescent shaped
common location of subdural hematomas
supratentorial, located along the convexity. freq seen along the falx and tentorium
subdural collections will not cross the falx cerebri and tentorium due to
dural reflections form falx cerebri and tentorium
subdural hematomas can cross sutures or not
can cross sutures
acute hemorrhage may appear isodense or hypodense on ct, in patients with what comorbidities
severe anemia or active extravasation (hyperacute subdural hematoma)
sediment level in extra-axial hematoma called _____ may be seen either from rebleeding or in patients with clotting disorders
hematocrit effect
contrast study may help distinguish chronic subdural hematoma from atrophy by the demonstration of
an enhancing capsule or displaced cortical veins
transition from acute to chronic subdural hematomas called isodense phase occurs usually between how many days to weeks after the acute event
several days and 3 weeks
indirect signs of subdural hemorrhage in isodense phase
effacement of sulci, effacement or distortion of the white matter (“white matter buckling”), abnormal separation of the gray-white matter junction from the inner table of the skull (“thick gray matter mantle”), distortion fo ventricles and midline shift
dependent layering of the acute, denser blood products within the chronic, hypodense collections is often referred to as the
“hematocrit sign”
acute subdural hematomas appearance on MRI
isointense to brain on T1, hypointense on T2
subacute subdural hematoma appearance on MRI
high signal on T1, due to presence of methemoglobin
as hemorrhage ages in chronic subdural hematomas, they appear what on MRI
T2 signal increases and T1 signal gradually decreases as the hge ages
shape of subacute subdural hematomas frequently have a ____ appearance when seen in the coronal plane
lentiform or biconvex appearance, rather than the crescent-shaped appearance that is characteristic on axial CT scans
extra-axial hemorrhage that is common in head injury but is rarely large enough to cause a significant mass effect. it results from the disruption of small subarachnoid vessels or direct extension into the subarachnoid space by a contusion or hematoma
subarachnoid hemorrhage
sensitive MR sequence in detecting hyperacute SAH
FLAIR and SWI
mechanisms of intraventricular hemorrhage
can result from rotationally induced tearing of subependymal veins on the surface of the ventricles, direct extension of a parenchymal hematoma into the ventricular system, intraventricula blood can result from retrograde flow of SAH into the ventricular system thru the fourth ventricular outflow foramina
patients with IVH are at risk for
subsequent hydrocephalus by obstruction either at the level of aqueduct or arachnoid villi
MC type of primary neuronal injuries in patients with severe head trauma
DAI
characterized by widespread disruption of axons that occurs at the time of an acceleration or deceleration injury. direct impact is not necessary to cause this type of injury
DAI
patients with this type of brain injury are most commonly due to high-speed motor vehicle crashes. these lesions have not been seen as a consequence of simple falls
DAI
loss of consciousness is typically seen in what brain injury that immediately occurs after this injury
DAI
DAI presents as
small petechial hges at the gray-white junction of the cerebral hemispheres or corpus callosum
On MR, nonhemorrhagic DAI lesions appear as
small foci of T2 prolongation (increased signal) on FLAIR images or low ADC on DWI within the white matter
hemorrhagic DAI appears as
low signal on GRE or SWI
characteristic locations of DAI in terms of severity
Mild- frontal and temporal white matter, near the gray-white junction, parasagittal regions of frontal lobes and periventricular regions of temporal lobes
More severe- lobar white matter as well as corpus callosum, esp posterior body and splenium
Most severe- dorsolateral aspect of midbrain and upper pons , in addition to lobar white matter and corpus callosum
part of brain that is affected by DAI in 20% of cases
corpus callosum
manner of injury in DAI of corpus callosum
rotational shear forces
corpus callosum is particularly susceptible to DAI because
the falx prevents displacement of the cerebral hemispheres
areas of focal brain injury primarily involving the superficial gray matter. this lesions are much less likely to have loss of consciousness at the time of injury than are the patients with DAI
cortical contusions
common sites for cortical contusions
temporal lobes above the petrous bone or posterior to the greater wing of sphenoid, frontal lobes above the cribriform plate, planum sphenoidale, lesser sphenoid wing, less than 10% involve the cerebellum, margins of depressed skull fractures
cause of markedly decreased signal on GRE or SWI as a sign of prior hemorrhage
hemosiderin deposit