Head trauma and spinal injury

Question 1

Where does traumatic axonal injury most commonly appear?

Answer 1

The corpus callosum

Question 1

Is grey or white matter predominantly affected in vasogenic cerebral oedema?

Answer 1

White matter

Question 1

Which type of cerebral oedema is responsive to steroid treatment?

Answer 1

Vasogenic

Question 2

What is the volume of CSF?

Answer 2

150mL

Question 3

What is a cause of chronic traumatic encephalopathy?

Answer 3

Repeated traumatic injury to the brain eg in boxers

Question 3

What occurs if rising ICP can’t be compensated for?

Answer 3

There is herniation of brain hemisphere through dural openings

Brain perfusion can cease if ICP overtakes cerebral perfusion pressure (CPP)

Question 3

What is vasogenic cerebral oedema caused by?

Answer 3

Blood-brain barrier disruption due to increased vascular permeability

Question 4

What is a concussion characterised by?

Answer 4

Temporary lose of consciousness, respiratory arrest and reflexes

Question 5

What are contusions?

Answer 5

Haemorrhagic necrosis in the brain

Question 6

Can subdural bleeds cause raised ICP?

Answer 6

Yes

Question 7

What are the longterm effects of diffuse axonal injury?

Answer 7

Brain atropy

Question 8

What are some non-acute effects of traumatic injury?

Answer 8

Infection

Epilepsy

Question 10

What are some acute secondary effects of traumatic injury?

Answer 10

Hypoxia

Ischaemia

Raised ICP

Question 12

How much does the scalp bleed?

Answer 12

A lot

Question 13

What is a common cause of concussion?

Answer 13

Rapid change of momentum of the brain

Question 14

What is it called when skull fractures have splintering of bone?

Answer 14

Comminuted

Question 15

What symptom is characteristic of subarachnoid bleeds?

Answer 15

A thunderclap headache

Question 15

What is chronic traumatic encephalopathy characteristed by?

Answer 15

Brain atropy due to neuronal lose

Abnormal deposition of Tau protein

Often deposition of A-beta plaques in the cortex

Question 17

When do subarachnoid haemorrhages generally occur?

Answer 17

Aneurysms following trauma

Question 18

How do old cerebral contusions appear?

Answer 18

Drooping of brain tissue along gyri and deposition of orange tissue - indicative of healing by macrophages and scarring

Question 18

What is hydrocephalus?

Answer 18

Dilation of the ventricles due to interruption of CSF flow - brain is damaged as a result

Question 21

Diffuse vascular injury affects which vessels?

Answer 21

V. small vessels

Question 22

Is grey or white matter affect in cytotoxic cerebral oedema?

Answer 22

Both

Question 23

Subdural haemorrhages are more common in which age group? Why?

Answer 23

The elderly because atropy of the brain tends to greater tension on the subdural veins making them more likely to tear

Question 25

Why are contusions on the base of the brain common?

Answer 25

Protuding, boney structures can be rubbed against

Question 26

In which age group are epidural bleeds less likely? Why?

Answer 26

The elderly because their dura adheres more strongly to the skull

Question 27

How does an atropied brain appear?

Answer 27

Enlarged ventricles Thin corpus callosum White matter is generally thinner

Question 28

What is a contrecoup?

Answer 28

When the brain bounces against the back wall of the skull resulting in injury to both sides of the brain

Question 29

What are the compensations for rising ICP?

Answer 29

Ventricles shrink Gyri flatten out Blood is forced out

Question 30

What is cytotoxic cerebral oedema caused by?

Answer 30

Increased intracellular fluid secondary to neuronal, glial, or endothelial cell injury

Question 31

What are common site for contusions on the base of the brain?

Answer 31

Inferior frontal lobe (eg olfactory bulbs) Inferiorlateral temporal lobe

Question 32

Subdural haemorrhage are due to damage to which vessels?

Answer 32

Subdural veins eg the superior cerebral veins

Question 33

What determines the damage done by a bullet?

Answer 33

The velocity of the bullet because that = kinetic energy = degree of shock waves

Question 34

What does blood/CSF from the nose or ears indicate?

Answer 34

Basal functure (fracture of the base of the skull)