Head Injuries

Question 1

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

Answer 1

RTA’s
Alcohol related incidents, including assault

Question 2

What is the primary concern in head injuries?

Answer 2

Focal and/or diffuse brain trauma

Question 3

What are some secondary concerns relating to head injuries?

Answer 3

Hypotension
Hypoxia
Infection
Haematoma

Question 4

Which classification is used to assess conscious level?

Answer 4

Glasgow Coma Scale

Question 5

List some consequences of head injuries.

Answer 5

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

Question 6

What is the forensic significance of head injuries?

Answer 6

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

Question 7

RECAP- name the layers of the scalp

Answer 7

Skin
Connective tissue
Epicardial aponeurosis
Loose alveolar connective tissue
Periosteum

Question 8

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

Answer 8

Dura mater

Question 9

Which type of mater are blood vessels found?

Answer 9

Arachnoid mater

Question 10

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

Answer 10

Pia mater

Question 11

List some injuries which can affect the scalp.

Answer 11

Bruises, abrasions, lacerations, incisions, burns/scalds

Question 12

What may obstruct observation of scalp wounds?

Answer 12

Hair

Question 13

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

Answer 13

Zygomatic arch

Question 14

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

Answer 14

Child’s skull is not fully fused

Question 15

List the different types of skull fractures you can get.

Answer 15

Linear
Depressed
Comminuted/mosaic
Ring
Contre-coup

Question 16

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

Answer 16

Temporal- parietal bones

Question 17

What can cause linear skull fracture?

Answer 17

Fall onto side or a blow on the head

Question 18

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

Answer 18

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

Question 19

Describe what is seen in a depressed skull fracture.

Answer 19

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

Question 20

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

Answer 20

Depressed skull fracture

Question 21

What is a cause of depressed skull fractures?

Answer 21

Weapons, particularly one like a hammer

Question 22

What does a ring skull fracture usually surround?

Answer 22

Foramen magnum

Question 23

What often causes a ring skull fracture?

Answer 23

Fall from height

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

Question 24

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

Answer 24

Orbital plates

Question 25

What often causes a contre-coup skull frcature?

Answer 25

Fall onto back of head

Question 26

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

Answer 26

Increase in intracranial pressure resulting in compression of brain

Question 27

As ICP increases without intervention, what will ultimately happen?

Answer 27

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

Question 28

Where would an extradural haemorrhage be found?

Answer 28

Between skull and outer surface of dura mater.

Question 29

What typically causes an extradural haemorrhage?

Answer 29

Blow to side of head

Question 30

Which artery may tear and cause an extradural haemorrhage?

Answer 30

Middle meningeal artery

Question 31

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

Answer 31

Extradural haemorrhage

Question 32

Where does a subdural haemorrhage occur?

Answer 32

Between dura and arachnoid mater

Question 33

Which vessels cause bleeding in a subdural haemorrhage?

Answer 33

Bridging veins

Question 34

What are subdural haemorrhages usually associated with?

Answer 34

Trauma e.g. accelerated fall

Question 35

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

Answer 35

Extradural haemorrhage

Question 36

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

Answer 36

Elderly ->often confused for dementia

Question 37

Which intracranial haemorrhage is the most common?

Answer 37

Subarachnoid haemorrhage

Question 38

Where does subarachnoid haemorrhage occur?

Answer 38

Between arachnoid mater and brain

Question 39

What is usually the cause of subarachnoid haemorrhage?

Answer 39

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

Question 40

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

Answer 40

Circle of Willis

Question 41

What us traumatic basal subarachnoid haemorrhage?

Answer 41

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

Question 42

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

Answer 42

Rupture of vertebra-basilar circulation

Question 43

What are cerebral contrusions?

Answer 43

Bruises on the brain surface

Question 44

What is meant by a coup contusion?

Answer 44

Contusions/bruising beneath point of injury

Question 45

What is meant by a contracoup lesion?

Answer 45

Injury on opposite side of brain due to secondary brain movement

Question 46

What are cerebral lacertions?

Answer 46

Tears on the brain surface

Question 47

What is traumatic diffuse axonal injuries?

Answer 47

Tearing of nerve fibres in the white matter of the brain

Question 48

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

Answer 48

Often unconscious immediately, particularly if brainstem is affected

Question 49

What is traumatic diffuse axonal injuries associated with?

Answer 49

RTA Falling from height Occasionally assault

Question 50

What happens to cause a traumatic diffuse axonal injury?

Answer 50

High force rotational acceleration/deceleration injury

Question 51

What is cerebral oedema?

Answer 51

Generalised brain swelling in response to focal/diffuse injury

Question 52

What can cerebral oedema cause to occur?

Answer 52

Secondary brain ischaemia leading to further swelling

Question 53

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

Answer 53

Death ->due to development of raised ICP