Head injury and SOL (pathology)

Question 1

types of head injury trauma

Answer 1

missile

non missile

Question 2

missile injury

Answer 2

focal damage
lacerations, haemorrhage in brain lesion
high/low velocity

Question 3

non missile injury

Answer 3

sudden acceleration/deceleration of the head
brain moves within the cranial cavity and makes contact with bony protrusions

RTAs, falls, assaults

Question 4

non missile injury pathophysiology

Answer 4

primary injury - impact

secondary injury - evolves after primary injury, potential treatable

Question 5

scalp lesions

Answer 5

bruising
lacerations
bleeding
route for infection

Question 6

skull fracture types

Answer 6

fissure
depressed
compound - assoc with scalp lacerations
base of skull

Question 7

surface contusions and lacerations

Answer 7

lateral surface of hemispheres
undersurface of temporal and frontal lobes
coup (at point of impact) and contra coup (diametrically opposite point of impact) [contra more serious]

Question 8

diffuse axonal injury occurs when
can cause what
can lead to what

leads to what/caused by what

Answer 8

at moment of injury
coma
vegetative state

trauma, raised intracranial pressure, progression of inflam disease, progression of dementia, hypoxia

Question 9

diffuse axonal injury pathology 2-4 hours
12-24
24-2 months
2 months - 5 months
2 months - years

Answer 9

focal axonal accumulation of app

axonal varicosity

axonal swelling

glial reaction

degeneration and loss of myelinated fibres

Question 10

traumatic intracranial haematomas

Answer 10

10% extra dural

56% intra dural

• 13% subdural
• 3% sub arachnoid
• 15% discrete intracranial/intra cerebellar haematomas not in continuity with the surface of the brain
• 25% burst lobe - intracranial/intracerebral hematomas in continuity with a related subdural haematoma

Question 11

traumatic extradural haematomas
usually a cx of what
if unrx what will happen
associated what

Answer 11

fracture in temparoparietal region that involves the middle menangial artery

midline shift - compression and herniation

associated brain damage often minimal

Question 12

raised ICP process

normal ICP value

Answer 12

if brain enlarges some blood +/- CSF must escape from cranial vault to avoid rise in pressure
one this process is exhausted venous sinuses are flattened and there is little or no CSF
any further increase in brain volume will lead to a rapid increase in ICP

5-12mmHg

Question 13

causes of raised ICP

Answer 13

focal lesion in the brain 
diffuse lesions - oedema
increased CSF - hydrocephalus
increased venous volume 
physiological - hypoxia, hypercapnia, pain

Question 14

effects of increased ICP

Answer 14

intracranial shifts and herniations
distortion and pressure on CNs and vital neurological centres
reduced level of consciousness
impaired blood flow

Question 15

common forms of herniations

Answer 15

falcine
uncal
cerebellar
transcalvarium

Question 16

clinical signs of raised ICP

Answer 16

papilloedema
n and v
headache
neck stiffness

Question 17

SOL

Answer 17

tumours
abscess
haematoma
localised brain swelling

Question 18

abscesses single/multiple

Answer 18

can arise in significant bacterial meningitis

single - otisi media, sinusitis, nasal facial and dental infections, skull fracture penetrating injury

multiple - septicemia, acute bacterial endocarditis, bronchiectasis and lung abscess, cyanotic heart disease, IVD abuse

Question 19

focal oedema is what

Answer 19

localised oedema which is present as a result of other pathalogical lesions such as infarcts, can also lead to an increase in intracranial pressure

Question 20

generalised cerebral oedema

Answer 20

increased what content of the brain

Question 21

extradural haemorrhage

Answer 21

usually due to rupture of meningeal arteries and associated with skull fractures

compress subjacent dura and flatten gyral crests of underlying brain

Question 22

subdural haemorrhages

Answer 22

collections of blood between the internal surface of dura mater and arachnoid mater
caused by disruption of bridging veins that extend from he surface of the brain into subdural space

most often over cerebral hemispheres
vary in site
acute (clotted blood)
chronic (liquified blood)

Question 23

acute subdural haemorrhage history

Answer 23

clear history of trauma 
assoc with other traumatic lesions 
gyral contours preserved
swelling of cerebrum on side of haematoma 
mass effect

Question 24

chronic sub dural haemorrhage

clinical symptoms

Answer 24

less frequently associated with a well defined traumatic insult
often assoc with brain atrophy
composed of liquified blood/yellow tinged fluid separated from inner surface of dura matar and underlying brain by neomembrane

altered mental state
focal neurological deficits