Forensic Pathology of Head injuries

Question 1

What is a traumatic head injury assed by

Answer 1

GCS ( ocular , motor, verbal )

Question 2

List 4 types of head injury

Answer 2

1- Blunt
2- Missile
3- Acc/Dec forces
4- Penetrating

Question 3

What is the primary damage ( immediate ) that could occur from a traumatic head injury

Answer 3

1- scalp laceration 
2- skull fracture 
3- cerebral contusions 
4- cerebelar lacerations 
5- intracranial haemorrhage 
6- diffuse axonal injury

Question 4

What is the secondary ( delayed ) damage that could occur from a traumatic head injury

Answer 4

1- Ischaemia
2- hypoxia
3- cerebelar swelling
4- infection

Question 5

What type of diffuse distribution could occur from a head injury

Answer 5

1- Diffuse axonal injury
2- diffuse vascular injury
3- hypoxic ischaemic damage
4- diffuse brain swelling

Question 6

What are contusions

Answer 6

Bruises

Question 7

What are abrasions

Answer 7

scratches / grazes

Question 8

What are lacerations

Answer 8

cuts / tears

Question 9

What are the possible types of skull fractures

Answer 9

1- linear 
2- Depressed 
3- Contra-coup 
4- Hinge 
5- Ring 
6- Diastatic 
7- Pond ( ripple / spider web )

Question 10

Where is a extradural haemorrhage

Answer 10

Between the dura and the skull

Question 11

What causes a extradural haemorrhage

Answer 11

Torn vessels in the meninges in association with the skull.

Common : a fracture to the squamous temporal bone causing damage to middle meningeal artery

Question 12

Death from to extradural haemorrhage is normally due to

Answer 12

Cerebral compression and herniation

Question 13

What is a lucid interval in extradural haemorrhage

Answer 13

Time between injury and death where there is an slow accumulation of blood. person will be conscious

Question 14

What usually causes a subdural haemorrhage

Answer 14

tearing of bridging veins that empty into the superior sagittal sinus

Question 15

Where is a subdural haemorrhage

Answer 15

between inner surface of dura and arachnoid layer

Question 16

Which group of people are at a high risk of subdural haemorrhage

Answer 16

Elderly and alcoholics

Question 17

Which haemorrhage can occur after a relatively minor head injury

Answer 17

Subdural haemorrhage

Question 18

What is the normal presentation of a subdural haemorrhage within 48hrs

Answer 18

Headache and maybe confusion

Question 19

What are the common areas of cerebral contusions

Answer 19

1- Frontal poles
2- Orbital surface of frontal poles
3- Temporal poles
4- Cortex adjacent to Sylvia tissue

Question 20

What is Coup injury vs contrecoup injury

Answer 20

Coup: injury at the point of contact
Countercoup: injury to surface opposite to the point of contact

Question 21

When does a countercoup injury occur and what does it indicate

Answer 21

Occurs : after sudden deceleration

Indicated movement of head at injury

Question 22

What is a cerebral contusion

Answer 22

superficial bruise of the brain

Question 23

What are the possible bleeding sources of a traumatic subarachnoid

Answer 23

1- severe contusions / lacerations
2- skill fracture tearing vessels at brain base
3- rupture of vertebral arteries dissection
4- blood form intraventricular haemorrhage

Question 24

Due to blockage of CSF subarachnoid haemorrhage may cause ..

Answer 24

Hydrocephalus

Question 25

What is diffuse axonal injury

Answer 25

Widespread traumatic axonal image

Question 26

What is the clinical presentation of diffuse axonal injury

Answer 26

1- unconscious from moment of impact 2- no lucid interval 3- remains unconscious in a vegetative state or severely disabled

Question 27

What is the histological presentation of diffuse axonal injury

Answer 27

1- wide spread axonal swelling

Question 28

Clinical features of raised ICP

Answer 28

``` 1- Headache 2- Vomiting 3- Confusion 4- Focal neurological signs : paralysis , hemianopia , dysphasia 5- depressed conscious level 6- seizure 7- papilloedema ```

Question 29

What are the effects of raised ICP

Answer 29

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

Question 30

What is uncle herniation

Answer 30

When raised ICP causes portions of the brain to move form one intracranial compartment to another

Question 31

What is a duet haemorrhage

Answer 31

small linear areas of bleeding in the midbrain and upper pons of the brainstem. caused by traumatic downward displacement of brainstem