Forensic Pathology of Head injuries Flashcards
What is a traumatic head injury assed by
GCS ( ocular , motor, verbal )
List 4 types of head injury
1- Blunt
2- Missile
3- Acc/Dec forces
4- Penetrating
What is the primary damage ( immediate ) that could occur from a traumatic head injury
1- scalp laceration 2- skull fracture 3- cerebral contusions 4- cerebelar lacerations 5- intracranial haemorrhage 6- diffuse axonal injury
What is the secondary ( delayed ) damage that could occur from a traumatic head injury
1- Ischaemia
2- hypoxia
3- cerebelar swelling
4- infection
What type of diffuse distribution could occur from a head injury
1- Diffuse axonal injury
2- diffuse vascular injury
3- hypoxic ischaemic damage
4- diffuse brain swelling
What are contusions
Bruises
What are abrasions
scratches / grazes
What are lacerations
cuts / tears
What are the possible types of skull fractures
1- linear 2- Depressed 3- Contra-coup 4- Hinge 5- Ring 6- Diastatic 7- Pond ( ripple / spider web )
Where is a extradural haemorrhage
Between the dura and the skull
What causes a extradural haemorrhage
Torn vessels in the meninges in association with the skull.
Common : a fracture to the squamous temporal bone causing damage to middle meningeal artery
Death from to extradural haemorrhage is normally due to
Cerebral compression and herniation
What is a lucid interval in extradural haemorrhage
Time between injury and death where there is an slow accumulation of blood. person will be conscious
What usually causes a subdural haemorrhage
tearing of bridging veins that empty into the superior sagittal sinus
Where is a subdural haemorrhage
between inner surface of dura and arachnoid layer
Which group of people are at a high risk of subdural haemorrhage
Elderly and alcoholics
Which haemorrhage can occur after a relatively minor head injury
Subdural haemorrhage
What is the normal presentation of a subdural haemorrhage within 48hrs
Headache and maybe confusion
What are the common areas of cerebral contusions
1- Frontal poles
2- Orbital surface of frontal poles
3- Temporal poles
4- Cortex adjacent to Sylvia tissue
What is Coup injury vs contrecoup injury
Coup: injury at the point of contact
Countercoup: injury to surface opposite to the point of contact
When does a countercoup injury occur and what does it indicate
Occurs : after sudden deceleration
Indicated movement of head at injury
What is a cerebral contusion
superficial bruise of the brain
What are the possible bleeding sources of a traumatic subarachnoid
1- severe contusions / lacerations
2- skill fracture tearing vessels at brain base
3- rupture of vertebral arteries dissection
4- blood form intraventricular haemorrhage
Due to blockage of CSF subarachnoid haemorrhage may cause ..
Hydrocephalus
What is diffuse axonal injury
Widespread traumatic axonal image
What is the clinical presentation of diffuse axonal injury
1- unconscious from moment of impact
2- no lucid interval
3- remains unconscious in a vegetative state or severely disabled
What is the histological presentation of diffuse axonal injury
1- wide spread axonal swelling
Clinical features of raised ICP
1- Headache 2- Vomiting 3- Confusion 4- Focal neurological signs : paralysis , hemianopia , dysphasia 5- depressed conscious level 6- seizure 7- papilloedema
What are the effects of raised ICP
1- Flattening of gyros pattern
2- compression of ventricle on same side as lesion
3- lateral shift of midline structures is lesion unilateral
4- internal herniation
What is uncle herniation
When raised ICP causes portions of the brain to move form one intracranial compartment to another
What is a duet haemorrhage
small linear areas of bleeding in the midbrain and upper pons of the brainstem. caused by traumatic downward displacement of brainstem
