Head Trauma

Question 1

Name and describe five types of skull fracture

Answer 1

Linear- Commonly tempero-parietal and along sutures, can spread to base of skull (hinge)
Depressed-Tend to be from hammer and can fragment to corrupt blood vessels and meninges
Comminuted-fractured skull like a mosaic
Ring-fracture round the foramen magnum from either falling from height and landing on feet or head which can compress brain.
Contre-coup-have original injury then a resulting injury diagonal from this from the brain moving

Question 2

Categorise head injuries according to GCS

Answer 2

Severe- 3-8
Moderate-9-12
Mild-13-15

Question 3

What are the common causes of an extra dural haemorrhage and how does it manifest?

Answer 3

Ruptured middle meningeal artery from a fractured squamous temporal bone from a fall.
Venous channels can also cause it.
Presents with a lucid interval with no neurological symptoms after the event then deteriorate later

Question 4

What can cause a subdural haemorrhage and what patients are most at risk for these?

Answer 4

Bridging veins can be easily torn often without need of a fracture, less pressure means it is a slower bleed so can have long lucid interval.
Patients with small brains are more at risk due to bridging veins already being stretched and brain able to move more.
Can have chronic bleeds in elderly patients which can be confused for dementia as it causes confusion.

Question 5

What can cause a subarachnoid haemorrhage and what is its presentation?

Answer 5

Most commonly from trauma or from a natural rupture of cerebral aneurysm, associated with cerebral contusion.
Presents with a thunderclap headache and rapid collapse. Death can be quick due to irritation of the arachnoid mater.

Question 6

What is a traumatic basal SAH?

Answer 6

Sudden blow to side of face or neck causes rupturing of vertebral arteries at the base of the skull from the quick rotation. Person goes into cardiac arrest straight away and are usually dead before they hit the floor as brain stem twists as well.

Question 7

What is a traumatic diffuse axonal injury caused by, how is it diagnosed and what parts of the brain are most commonly affected?

Answer 7

Usually falls from height or car crashes that have severe rotational forces to rupture the axons.
Can only be diagnosed by microscopy by using a special stain (APP) to see the brain matter but damage to small vessels in the brain can arouse suspicion.
Can occur in corpus callosum, para-sagittal white matter, posterior internal capsule and dorsolateral aspects of the rostral brainstem, as well as the cerebellar peduncles