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head injury Flashcards

1
Q

what is a non- missile head injury?

A

one where the dura mater remains intact. there may or may not be skull fracture

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2
Q

what is a missile head injury?

A

one where there is penetration of the skull and dura mater

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3
Q

what are the different types of distribution of lesions?

A

focal

diffuse

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4
Q

what is primary damage?

A

damage due to the immediate biophysical forces of trauma

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5
Q

what is secondary damage?

A 
presents some time after the traumatic event 
eg 
- physiological response to trauma 
hypoxia/ischaemia 
infection
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6
Q

what are the different cuases of focal damage after non-missile trauma?

A

scalp:
contusion
laceration

skull:
fracture

meninges:
haemorrhage
infection

brain: 
contusion
laceration 
haemorrhage 
infection
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7
Q

what are the different types of diffuse brain lesions that can occur after non-missile trauma?

A

diffuse axonal injury
diffuse vascular injury
hypoxia-ischaemia
swelling

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8
Q

what are the possible sequelae from skull fracture?

A

haematoma
infection
aerocele

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9
Q

what type of fractures do flat surfaces cause?

A

linear fractures

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10
Q

what type of fractures do angled or pointed objects cause?

A

localised fractures that are open or depressed

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11
Q

what is an extradural haemorrhage usually associated with?

A

skull fracture

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12
Q

what is the onset of an extradural haemorrhage like?

A

occurs slowly over several hours

usually a lucid interval - where a pt temporarily improves and then deteriorates again

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13
Q

how does an extradural haematoma cause death?

A

brain displacement
raised intracranial pressure
herniation

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14
Q

what is a subdural haematoma due to ?

A

tear in the bridging veins

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15
Q

what are subdural haematomas sometimes surrounded by?

A

a membrane of granulation tissue

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16
Q

what are the causes of subarachnoid haemmorhage?

A

contusions/lacerations
base of skull fracture
vertebral artery rupture or dissection
intraventricular haemorrhage

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17
Q

when does superficial haemorrhage occur?

A

when there is severe contusion

18
Q

when does deep haemorrhage occur?

A

when there is diffuse axonal injury

19
Q

what is the predominant cause of infection in TBI?

A

skull fracture

20
Q

what are the 2 different brain damage mechanisms leading to focal brain damage?

A

contact damage

acceleration or deceleration damage

21
Q

what is contact damage?

A

damage at or just deep to the point of impact

22
Q

What is acceleration or deceleration damage?

A
  • force causes differential movement of skull and brain
  • impact of inner surface of skull on underlying brain causes contusions
  • traction on bridging veins causes subdural haemorrhage
  • damages blood vessels and axons
23
Q

What is a contusion?

A

superficial bruising of the brain

may lead to prolonged coma, focal signs and lasting damage

24
Q

what does it mean if the contusion is described as ‘coup’?

A

the bruising is at the site of the impact

25
Q

what does it mean if the contusion is contrecoup?

A

bruising of the brain is away from the site of impact

26
Q

what is the progression of the macroscopic appearance of the brain in contusion?

A

haemorrhagic at first
then brown/orange and soft after days-weeks
then indented or cavitated after months or years

27
Q

what is a laceration?

A

When contusion is sufficiently severe to tear the pia mater

28
Q

what is diffuse axonal injury?

A

a type of diffuse lesion after non-missile trauma that results in widespread axonal damage
it is usually due to acceleration and deceleration of the head

29
Q

what is diffuse vascular injury?

A

Multiple petechial haemorrhages throughout brain

Usually result in near immediate death

30
Q

what are the different mechanisms of brain swelling?

A
  1. congestive brain swelling - due to vasodilation and increased in cerebral blood volume
  2. vasogenic oedema - extravasation of oedema fluid from damaged blood vessels
  3. cytotoxic oedema - a disruption in cellular metabolism impairs functioning of the sodium and potassium pump in the glial cell membrane, leading to cellular retention of sodium and water in neurones and glia
31
Q

what are 2 causes of brain herniation?

A

bleeding

swelling of the brain

32
Q

when does hypoxia-ischaemia occur?

A

pts who are hypoxic
hypotension with BP <80 for 15mins
increased intracranial pressure

33
Q

describe the distribution of hypoxia-ischaemia

A

can be widespread or confined to vulnerable regions eg border zones between major cerebral vessels

34
Q

what are the features of penetrating missile head injuries?

A

cause focal damage
no loss of consciousness
eg low velocity bullet

35
Q

what are the complications of penetrating missile injuries?

A

high risk of infection

epilepsy

36
Q

what are the features of perforating missile injuries?

A

missile enters and exits skull, passing through the brain
eg high velocity bullet
exit wound is worse than the entry wound
damage produced by shock waves and cavitation

37
Q

what is chronic traumatic encephalopathy?

A

Neurodegenerative condition usually seen 8-10 years after

due to repetitive mild TBI

38
Q

What are the clinical features of chronic traumatic encephalopathy?

A

irritability, impulsivity, aggression, depression, memory loss
dementia, gait and speech problems, Parkinsonism
1/3 are progressive
may have MND-like symptoms

39
Q

what are the pathological features of chronic traumatic encephalopathy?

A

• atrophy of the neocortex, hippocampus, diencephalon and mamillary bodies
enlarged ventricles
• also affects frontal, temporal cortex and limbic regions
• tau positive neurofibrillary and astrocytic tangles

40
Q

what are the 2 different types of spinal injury?

A

indirect (usually closed)

direct due to penetration by an external object eg a knife

41
Q

what is the commonest place to have a spinal injury?

A

cervical

Neuro (9 decks)

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