Head Injuries Flashcards
In the UK, what are the most common related head injuries?
RTA’s
Alcohol related incidents, including assault
What is the primary concern in head injuries?
Focal and/or diffuse brain trauma
What are some secondary concerns relating to head injuries?
Hypotension
Hypoxia
Infection
Haematoma
Which classification is used to assess conscious level?
Glasgow Coma Scale
List some consequences of head injuries.
Permanent physical disability
Post traumatic epilepsy
Intracranial infection
Psychiatric illness
Chronic subdural haemorrhage
Punch-drunk dementia
Fatal outcome
What is the forensic significance of head injuries?
Need to establish if head injury was accidental, homicidal, suicidal etc.
RECAP- name the layers of the scalp
Skin
Connective tissue
Epicardial aponeurosis
Loose alveolar connective tissue
Periosteum
What is the fibrous outer layer of mater which is adhered to the inner layer or skull?
Dura mater
Which type of mater are blood vessels found?
Arachnoid mater
Which type of mater is adhered to the surface of the brain itself?
Pia mater
List some injuries which can affect the scalp.
Bruises, abrasions, lacerations, incisions, burns/scalds
What may obstruct observation of scalp wounds?
Hair
Which bone is often broken by a punch to the face or falling forward?
Zygomatic arch
Adult skulls are less able to cope with distortion than a child’s. Why is this?
Child’s skull is not fully fused
List the different types of skull fractures you can get.
Linear
Depressed
Comminuted/mosaic
Ring
Contre-coup
Linear skull fractures and one of the more simple skull fractures. Which bones are commonly involved?
Temporal- parietal bones
What can cause linear skull fracture?
Fall onto side or a blow on the head
Describe what is seen in a comminuted/mosaic skull fracture.
Fractures radiate away from point of impact, fragmented skull (like a mosaic)
Describe what is seen in a depressed skull fracture.
Focal impact which may push fragments inwards, potentially causing damage to the meninges, blood vessels and brain
In which type of skull fracture is there a higher risk of meningitis?
Depressed skull fracture
What is a cause of depressed skull fractures?
Weapons, particularly one like a hammer
What does a ring skull fracture usually surround?
Foramen magnum
What often causes a ring skull fracture?
Fall from height
->often is someone lands on feet as force radiates up and pushes spinal cord upwards leading to base of skull fractures
Which bones are usually affected in a contre-coup skull farcture?
Orbital plates
What often causes a contre-coup skull frcature?
Fall onto back of head
What does accumulation of blood within the rigid skull (intracranial haemorrhage) cause to happen?
Increase in intracranial pressure resulting in compression of brain
As ICP increases without intervention, what will ultimately happen?
Death as compression of brainstem due to herniation of cerebellar tonsils into foramen magnum
Where would an extradural haemorrhage be found?
Between skull and outer surface of dura mater.
What typically causes an extradural haemorrhage?
Blow to side of head
Which artery may tear and cause an extradural haemorrhage?
Middle meningeal artery
Which type of intracranial haemorrhage may the patient present okay with no neurological symptoms but can deteriorate rapidly later o?
Extradural haemorrhage
Where does a subdural haemorrhage occur?
Between dura and arachnoid mater
Which vessels cause bleeding in a subdural haemorrhage?
Bridging veins
What are subdural haemorrhages usually associated with?
Trauma e.g. accelerated fall
In which type of intracranial haemorrhage is it more likely to get a skull fracture?
Extradural haemorrhage
Which individuals are more likely to develop a chronic subdural haemorrhage?
Elderly
->often confused for dementia
Which intracranial haemorrhage is the most common?
Subarachnoid haemorrhage
Where does subarachnoid haemorrhage occur?
Between arachnoid mater and brain
What is usually the cause of subarachnoid haemorrhage?
Natural disease e.g. rupture of cerebral artery/ berry aneurysm
Which area of the brain does a berry aneurysm usually occur?
Circle of Willis
What us traumatic basal subarachnoid haemorrhage?
Type of subarachnoid haemorrhage usually as the result of forceful impact to the upper part of the side of neck.
Traumatic basal subarachnoid haemorrhage usually involves the patient abruptly rotating their head during the injury. What does this movement cause to happen?
Rupture of vertebra-basilar circulation
What are cerebral contrusions?
Bruises on the brain surface
What is meant by a coup contusion?
Contusions/bruising beneath point of injury
What is meant by a contracoup lesion?
Injury on opposite side of brain due to secondary brain movement
What are cerebral lacertions?
Tears on the brain surface
What is traumatic diffuse axonal injuries?
Tearing of nerve fibres in the white matter of the brain
What happens to a person with a traumatic diffuse axonal injury?
Often unconscious immediately, particularly if brainstem is affected
What is traumatic diffuse axonal injuries associated with?
RTA
Falling from height
Occasionally assault
What happens to cause a traumatic diffuse axonal injury?
High force rotational acceleration/deceleration injury
What is cerebral oedema?
Generalised brain swelling in response to focal/diffuse injury
What can cerebral oedema cause to occur?
Secondary brain ischaemia leading to further swelling
What is brain swelling often the cause of in fatal head injuries?
Death
->due to development of raised ICP
