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Forensics > Head Injuries > Flashcards

Head Injuries Flashcards

1
Q

5 layers of the scalp

A
  • Surface of skin (abrasions)
  • connective layer (lacerations)
  • aponeurosis (contusion)
  • loose areolar tissue (incision/stab)
  • periosteum (firearm)
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2
Q

Sharp force injuries to skull

A
  • slot fractures

- transorbital stabs

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3
Q

Local deformation of skull

A
  • linear fracture
  • depressed fracture
  • indentation (with or without recoil)
  • cephalhaematoma
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4
Q

General deformation of skull

A
  • linear fractures of base and vault

- fractures by diastasis/ bursting of suture lines

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5
Q

Indirect application of force to skulls occurs when:

A
  • condule of mandible into base of skull

- vertebrae upwards into base of skull

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6
Q

Primary events to the meninges

A
  • extradural haematoma
  • subdural haematoma
  • subarachnoidal haemorrhage
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7
Q

Types of subdural haematoma/collection

A
  • acute
  • chronic
  • subdural effusions
  • subdural hygroma
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8
Q

Primary events to the brain

A
  • diffuse neuronal injury
  • diffuse axonal injury
  • lacerations
  • subpial haemorrhage
  • cortical contusions
  • intracerebral haemorrhages
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9
Q

Secondary events

A
  • cerebral oedema
  • increased intracranial pressure
  • secondary infections
  • secondary effects on vessels
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10
Q

Complications of cerebral oedema

A
  • herniation
  • vascular complications
  • cranial nerve damage
  • acute anoxic damage
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11
Q

Types of herniation

A
  • subflax
  • central downwards
  • parahippocampal gyrus herniation
  • interior cerebellar or tonsillar herniation
  • superior cerebellar herniation
  • burr-hole herniation
  • cerebral mushroom
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12
Q

Secondary infections

A
  • meningitis
  • subdural or epidural abscess
  • cerebral abscess
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13
Q

Acutes effects of boxing

A
  • rotational acceleration
  • linear acceleration (hyper-extension)
  • injury to carotid area
  • impact deceleration
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14
Q

Pathological findings in chronic brain damage (punch-drunk syndrome)

A
  • cerebral atrophy with enlarged ventricles
  • loss of cells in cerebellum
  • loss of nerve cells in substantia nigra
  • widespread neuronal damage in cerebral cortex
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15
Q

Types of bleeds (extra vs sub)

A

Extradural - arterial (MMA)

Subdural - venous

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16
Q

Complications of acute extradural haemorrhage

A
  • transtentorial herniation

- CN III palsy

17
Q

Mechanisms of injury in acute subdural haemorrhage

A
  • angular acceleration or decel
  • tearing of bridging veins between dura and cortical surface of the brain
  • child abuse
18
Q

Mechanisms of injury for subarachnoid haemorrhage

A
  • shear stress with rotational movement
  • impact with contusion and laceration
  • intracerebral haemorrhage breaking through cortex
  • vertebral artery damage
  • berry aneurysm
19
Q

Types of intracerebral haemorrhage

A
  • lobar

- basal ganglia

20
Q

Associations with basal ganglia hematoma

A
  • diffuse axonal injury
  • gliding contusions
  • severe hypertension
  • decorticate/decerebrate posturing
21
Q

Where do acute brain contusions occur?

A
  • over the the crest of the gyri

- conical appearance

22
Q

Clinical presentation of diffuse axonal injury

A
  • immidiate LOC or concussion
  • GCS <8
  • prolonged vegetative state
23
Q

Mechanisms of injury in diffuse axonal injury

A
  • diffuse tearing of axons
  • shearing forces
  • radiologically invisible
  • small haemorrhages
24
Q

Macroscopic features of DAI

A
  • gliding contusions
  • small deep grey matter haemorrhage
  • punctate hg in corpus callosum
  • brainstem hgs
25
Q

Microscopic features of DAI

A

retraction balls

26
Q

Complications of subfalcine herniation

A
  • ipsilateral compression of ventricle
  • unilateral obstrucive hydrocephalus
  • compresses ACA
27
Q

Effects of central herniation

A
  • midbrain moves downwards
  • effacement of the interpeduncular fossa
  • causes brainstem haemorrhages (Duret
  • often fatal
28
Q

Effects of uncal herniation

A
  • CN III down and out
  • ipsilat PCA (contralat HH)
  • contralat crus cerebri at the Kernohan’s notch (ipsilat paresis)
  • aqueduct compression
29
Q

Effects of cerebelllar herniation

A
  • compression of brianstem

- coma and death

30
Q

Types of internal herniations

A
  • rostral (SOL in posterior cranial fossa)

- limen insulae (basal aspect of frontal lobe sliding over wing of sphenoid bone

Forensics (14 decks)

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