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Applied Neuroanatomy > Head Injury and Space Occupying Lesions > Flashcards

Head Injury and Space Occupying Lesions Flashcards

1
Q

what is the head trauma death rate?

A

10 per 100,000

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2
Q

what kind of injury can head trauma be?

A

missile (open wound)

non-missile

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3
Q

Which form of head trauma leaves the dura intact?

A

non-missle

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4
Q

What are the features of missile damage?

A

focal damage
lacerations
haemorrhage in region of brain damage
high/low velocity

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5
Q

What are the features of non-missile damage?

A

sudden acceleration/deceleration of the head
brain moves in cranial cavity
general causes are RTAs and Assualt falls
primary injury -> evolves to secondary injury

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6
Q

When is injury in non-missile maximal?

A

at time of injury

  • shear injury to axons and/or
  • laceration or contusions of brain tissue
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7
Q

Where are surface contusions and lacerations found?

A

found on lateral surface of the hemispheres and undersurface of temporal and frontal lobes

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8
Q

What kind of injury can surface contusions and lacerations be and which is more serious??

A

coup or contracoup (diametrically opposite) contracoup more serious

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9
Q

Where may the surface contusions extend?

A

into the subcortical white matter

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10
Q

What causes contracoup injuries?

A

the brain moving back and forth in the skull

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11
Q

What are cerebral contusions?

A

traumatic/mechanical disruptions of small capillary vessels which are a mix of whole blood and native tissue (plasma, RBCs)
have a mottled/speckled density

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12
Q

What are the commonalities of intracranial haematomas?

A

10% extradural

56% intradural

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13
Q

What is an extradural haematoma?

A

blood is between the dura and skull and as it expands removes dura from the skull

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14
Q

What are the forms of intradural haematomas and their commonalities?

A
  • 13% subdural - dura and arachnoid
  • 3% subarachnoid - trauma from unusual circumstances
  • 15% discrete intracerebral/intracerebellar hematomas
  • 25% burst lobe - intracranial/intracerebral haematoma in continuity with a related subdural heamatoma - very serious
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15
Q

What increases the likelihood of serious brain injury and why?

A

age - as you get older the brain starts to atrophy and thus increases space between brain and skull

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16
Q

What is traumatic extradural hematoma?

A

usually a complication of a fracture in the temporoparietal region that involved the middle meningeal artery - can cause mid-line shift and herniation
minimal associated brain damage

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17
Q

What can traumatic extradural hematoma cause?

A

midline shift and herniation - life threatening

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18
Q

Where is traumatic extradural hematoma present?

A

in 10% of fatal cases

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19
Q

What is a subdural hematoma?

A

haemorrhage in between dura and arachnoid

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20
Q

What is subdural hematoma caused by?

A

tearing of the venous vessels that transverse the subdural space

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21
Q

What are the types of subdural hematoma?

A

acute
chronic
gross

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22
Q

How is an acute subdural hematoma classified?

A

sever head injury with rapid accumulation of blood

acute neurological deterioration

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23
Q

How is chronic subdural hematoma classified?

A

only in v.young and v.old
minimal trauma
slow accumulations of blood - enlarges over weeks

24
Q

How is gross subdural hematoma classified?

A

acute layer of gelatinous blood

chronic - organised layer of dark, liquified clot surrounded by membranes -> compress the brain

25
Q

When does raised intracranial pressure occur?

A

when the volume of brain, CSF and blood exceed the normal of 1600ml

26
Q

Why is the skull a disadvantage at times?

A

with increased intracranial pressure it does not allow for expansion of brain parenchyma or CSF volume without a raise in pressure

27
Q

What are signs of raised intracranial pressure?

A
  • papilloedema - pressure on the optic nerve
  • nausea and vomiting due to pressure in vomiting centre in pons and medulla
  • headache due to distortion of the dura
  • neck stiffness due to pressure on dura around cerebellum and brain stem
28
Q

Where does brain herniation occur?

A

through the routes of weakest resistance as a result of raised intracranial pressure

29
Q

What are the potential routes of herniation?

A

subfalcine
tentorial
tonsilar
transcalvarium

30
Q

Where does the subfalcine herniation occur?

A

cingulate gyrus

31
Q

What happens with the subfalcine herniation?

A

unilateral or assymetric expansion of the cerebral hemisphere displaces the cingulate gyrus under the falx cerebri

32
Q

What is associated with a subfalcine herniation?

A

compression of anterior cerebral artery
weakness and/or sensory loss in leg
ischemic injury to parts of primary and motor cortex

33
Q

Where is a tentorial herniation?

A

medial aspect of the temporal lobe - hippocampal uncus and parahippocampal gyrus

34
Q

What is associated with tentorial herniation?

A

ispsilateral 3rd cranial nerve affected
pupillary dilation
impairement of occular movements on side of lesion

35
Q

What is tonsilar herniation?

A

displacement of cerebellar tonsils through foramen magnum

36
Q

Why is tonsilar herniation life threatening?

A

causes brainstem compression - vital respiratory centres in medulla oblongata

37
Q

What is a trancalvarium herniation?

A

where the swollen brain will herniate through any defect in the dura or skill

38
Q

What is associated with a transcalvarium herniation?

A

reduction in conciousness
dilation of the pupil on same side as mass lesion
bradycardia
chenye-stoke respiration

39
Q

What is cheyne stoke respiration?

A

abnormal pattern of breathing with deeper and faster breaths followed by a gradual decrease that includes apnea - build up of CO2 in apnea -> hyperventilation-> apnea -> CO2

40
Q

What is a herniation usually treated with an why?

A

osmotic diuretic to reduce swelling

41
Q

What can be space occupying lesions?

A

brain tumours - primary or secondary (lungs tend to metastisize)
abscesses
heamatomas
localised brain swelling

42
Q

What are the potential effects of rotational forces?

A

rotation as you fall can cause diffuse axonal injury

  • initiates at moment of injury
  • can cause a coma
  • can lead to vegetative state
  • non-missile injury
43
Q

What occurs in rotational injuries?

A

widespread disruption to the axons due to shear and tensile strains - causing microglial cells throughout white matter weeks later

44
Q

Diffuse Axonal Injury (DAI) caused by?

A 
raised intracranial pressure
progression of inflammatory disease
progression of dementia
hypoxia
trauma - most common
45
Q

What are the pathological features of axons from DAI at 2-4 hours?

A

focal axonal accumulation of APP

46
Q

What are the pathological features of axons from DAI at 12-24hours?

A

axonal varicosity (swelling at the site)

47
Q

What are the pathological features of axons from DAI at 24hours -2 months?

A

axonal swelling

48
Q

What are the pathological features of axons from DAI at 2wks to 5 months?

A

glial reaction

49
Q

What are the pathological features of axons from DAI at 2mnths to years?

A

degeneration and loss of myelinated fibres

50
Q

What occurs to Nav channels in DAI?

A

increased expression and redistribution to demyelinated segments
expression of primitive 1.2 channel

51
Q

What does adjusted expression of Nav do?

A

partial restoration of conductance
has increased energy requirement
increased Na influx

52
Q

What happens to the calcium exhanger?

A

brings in calcium influx and activates calpains

causes cytoskeletal disruption and disrupted anterograde flow

53
Q

What is the issue with the calcium exchanger in head trauma?

A

not enough energy to remove Na -> need to cool area and use medically induced coma to slow electrical activity -> protect from excitotoxicity

54
Q

What is found in CTE?

A

Tau rather than Ab

55
Q

What is found in regards to tau in CTE?

A

tau proteins accumulate in CSF - correlates with severity
associated with repeated trauma - key regions of brain
NFTs associated with cerebral atrophy

56
Q

CTE

A

chronic traumatic encephalopathy

57
Q

encephalopathy

A

disease of the brain

Applied Neuroanatomy (11 decks)

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