Head Injuries Flashcards

1
Q

In the UK, what are the most common related head injuries?

A

RTA’s
Alcohol related incidents, including assault

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2
Q

What is the primary concern in head injuries?

A

Focal and/or diffuse brain trauma

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3
Q

What are some secondary concerns relating to head injuries?

A

Hypotension
Hypoxia
Infection
Haematoma

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4
Q

Which classification is used to assess conscious level?

A

Glasgow Coma Scale

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5
Q

List some consequences of head injuries.

A

Permanent physical disability
Post traumatic epilepsy
Intracranial infection
Psychiatric illness
Chronic subdural haemorrhage
Punch-drunk dementia
Fatal outcome

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6
Q

What is the forensic significance of head injuries?

A

Need to establish if head injury was accidental, homicidal, suicidal etc.

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7
Q

RECAP- name the layers of the scalp

A

Skin
Connective tissue
Epicardial aponeurosis
Loose alveolar connective tissue
Periosteum

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8
Q

What is the fibrous outer layer of mater which is adhered to the inner layer or skull?

A

Dura mater

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9
Q

Which type of mater are blood vessels found?

A

Arachnoid mater

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10
Q

Which type of mater is adhered to the surface of the brain itself?

A

Pia mater

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11
Q

List some injuries which can affect the scalp.

A

Bruises, abrasions, lacerations, incisions, burns/scalds

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12
Q

What may obstruct observation of scalp wounds?

A

Hair

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13
Q

Which bone is often broken by a punch to the face or falling forward?

A

Zygomatic arch

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14
Q

Adult skulls are less able to cope with distortion than a child’s. Why is this?

A

Child’s skull is not fully fused

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15
Q

List the different types of skull fractures you can get.

A

Linear
Depressed
Comminuted/mosaic
Ring
Contre-coup

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16
Q

Linear skull fractures and one of the more simple skull fractures. Which bones are commonly involved?

A

Temporal- parietal bones

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17
Q

What can cause linear skull fracture?

A

Fall onto side or a blow on the head

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18
Q

Describe what is seen in a comminuted/mosaic skull fracture.

A

Fractures radiate away from point of impact, fragmented skull (like a mosaic)

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19
Q

Describe what is seen in a depressed skull fracture.

A

Focal impact which may push fragments inwards, potentially causing damage to the meninges, blood vessels and brain

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20
Q

In which type of skull fracture is there a higher risk of meningitis?

A

Depressed skull fracture

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21
Q

What is a cause of depressed skull fractures?

A

Weapons, particularly one like a hammer

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22
Q

What does a ring skull fracture usually surround?

A

Foramen magnum

23
Q

What often causes a ring skull fracture?

A

Fall from height

->often is someone lands on feet as force radiates up and pushes spinal cord upwards leading to base of skull fractures

24
Q

Which bones are usually affected in a contre-coup skull farcture?

A

Orbital plates

25
Q

What often causes a contre-coup skull frcature?

A

Fall onto back of head

26
Q

What does accumulation of blood within the rigid skull (intracranial haemorrhage) cause to happen?

A

Increase in intracranial pressure resulting in compression of brain

27
Q

As ICP increases without intervention, what will ultimately happen?

A

Death as compression of brainstem due to herniation of cerebellar tonsils into foramen magnum

28
Q

Where would an extradural haemorrhage be found?

A

Between skull and outer surface of dura mater.

29
Q

What typically causes an extradural haemorrhage?

A

Blow to side of head

30
Q

Which artery may tear and cause an extradural haemorrhage?

A

Middle meningeal artery

31
Q

Which type of intracranial haemorrhage may the patient present okay with no neurological symptoms but can deteriorate rapidly later o?

A

Extradural haemorrhage

32
Q

Where does a subdural haemorrhage occur?

A

Between dura and arachnoid mater

33
Q

Which vessels cause bleeding in a subdural haemorrhage?

A

Bridging veins

34
Q

What are subdural haemorrhages usually associated with?

A

Trauma e.g. accelerated fall

35
Q

In which type of intracranial haemorrhage is it more likely to get a skull fracture?

A

Extradural haemorrhage

36
Q

Which individuals are more likely to develop a chronic subdural haemorrhage?

A

Elderly

->often confused for dementia

37
Q

Which intracranial haemorrhage is the most common?

A

Subarachnoid haemorrhage

38
Q

Where does subarachnoid haemorrhage occur?

A

Between arachnoid mater and brain

39
Q

What is usually the cause of subarachnoid haemorrhage?

A

Natural disease e.g. rupture of cerebral artery/ berry aneurysm

40
Q

Which area of the brain does a berry aneurysm usually occur?

A

Circle of Willis

41
Q

What us traumatic basal subarachnoid haemorrhage?

A

Type of subarachnoid haemorrhage usually as the result of forceful impact to the upper part of the side of neck.

42
Q

Traumatic basal subarachnoid haemorrhage usually involves the patient abruptly rotating their head during the injury. What does this movement cause to happen?

A

Rupture of vertebra-basilar circulation

43
Q

What are cerebral contrusions?

A

Bruises on the brain surface

44
Q

What is meant by a coup contusion?

A

Contusions/bruising beneath point of injury

45
Q

What is meant by a contracoup lesion?

A

Injury on opposite side of brain due to secondary brain movement

46
Q

What are cerebral lacertions?

A

Tears on the brain surface

47
Q

What is traumatic diffuse axonal injuries?

A

Tearing of nerve fibres in the white matter of the brain

48
Q

What happens to a person with a traumatic diffuse axonal injury?

A

Often unconscious immediately, particularly if brainstem is affected

49
Q

What is traumatic diffuse axonal injuries associated with?

A

RTA
Falling from height
Occasionally assault

50
Q

What happens to cause a traumatic diffuse axonal injury?

A

High force rotational acceleration/deceleration injury

51
Q

What is cerebral oedema?

A

Generalised brain swelling in response to focal/diffuse injury

52
Q

What can cerebral oedema cause to occur?

A

Secondary brain ischaemia leading to further swelling

53
Q

What is brain swelling often the cause of in fatal head injuries?

A

Death

->due to development of raised ICP

54
Q
A