Intracranial hemorrhage us and central nervous system Trauma Flashcards
Commonest type of intracerebral hemorrhage are associated with this disease
systemic hypertension
Main part of the brain affected by intracerebral hemorrhage due to systemic hypertension
80% basal ganglia putamen
60% hypothalamus pons cerebellum
Main population affected by intracerebral hemorrhage
People above 50 years old
Why is there a bleeding in intracerebral hemorrhage
MicroAneurysm Charcot Bouchard develop in penetrating branches coming from arteries at 90° and they may rupture into the ventricle and extend into subarachnoid space
Fibrinoid necrosis
Hyaline arteriosclerosis
Main cause of subarachnoid hemorrhage
Rupture of saccular berry aneurysm in circle of Willis. 40 to 65%
Other causes of subarachnoid hemorrhage
Bleeding diasthesis Tumor trauma hypertension vasculitis no cause. 20%
Do male and female have equally subarachnoid hemorrhage
Yes
Main arterie causing subarachnoid hemorrhage
Middle cerebral Artery 54 %
anterior artery 40%
basilar artery 4%
Two forms of central nervous system trauma
Heads injury
spinal injury
Two forms of head injury
Missile injury
non-missile injury
Examples of myself injury of head injury
Objects propelled through the air which enter cranial cavity causing focal damage
can be slow velocity missile or high velocity missile
Non-missile injury example
Sudden deceleration or acceleration of head which makes brain moves within cranial cavity
so damage of bony prominences and shear strain within the brain
Main reason of spinal injury
Compression due to main causes in head injury
What are the different types of legends of the scalp and skull
Laceration
bruising
Skull fracture
displaced fracture
What are the different type of skull fracture
Fissure fracture
Depressed fracture
Contrecoup fractures
Growing fractures seen in infancy
What is growing fracture
Brain tissue protrudes through fracture which prevents healing
What is a displaced fracture
fracture end displaced into cranial cavity more than thickness of the bone
If you are a wide awake which part of your skull is most at risk for fracture
Occipital
If you are in town choose which part of the skull is more at risk of fracture
Frontal
If you fall on the side which type of fracture are you most at risk to get
Basal fractures
What is cerebral contusion
Bruises of the brain generally due to strong blow to the head
Types of cerebral contusions
Coup contusions
Contrecoup contusions
HERNIATION contusion
Where does coup contusion appear
Site of impact
3
What is gliding contusion
Relative movement betweenParasagittal White matter and grey matter
Are herniation contusion always due to coup
No Can be due to pressure
Site of impacts of contrecoup contusions
On the diametrically opposite side
What is diffuse axonal injury
Widespread disruption of axons do you to shear and tensile strains at time of acceleration and deceleration
U Which form of contusion do you have increased incidence of diffuse axonal injury
In gliding contusions
Main parts of the brain affected by axonal injury
Brainstem
corpus callosum
What do you find in the brain of someone that survived for days to diffuse axonal injury
Axonal bulbs throughout white matter
Where do you find in the brain of someone that survived for weeks adiffuse axonal injury
Soft granular lesions clusters of microglia
What do you think in the brain of someone that survived for months a diffuse axonal injury
Degeneration of longs tracts
shrunken cystic scars
What is the common is cause of Cormel in the absence of intracranial hematoma
Diffuse axonal injury
After head injury which condition is because of severe disability
Diffuse axonal injury
Can you have concussion with mild form of diffuse axonal injury
Yes
What events can lead to diffuse axonal injury
A fall from considerable Heights
What is a concussion
Short lasting loss of consciousness
What happened if there is death within minutes of head injury
Multiple petechial hemorrhages in hemisphere especially white matter of frontal temporal lobes in brainstem
What structures are teared if there is tearing in the brainstem at the Ponto medullary Junction due to head injury
cranial nerves
Cavernous part of internal carotid causing cavernous fistula formed
pituitary stalk with infarction of anterior lobe
What happens if there’s a blow in the upper neck below the ear
Rupture of vertebral artery causing massive subarachnoid hemorrhage within posterior fossa
What happens in injury of the neck
Dissection of internal carotid artery causing thrombosis and eventually cerebral infarction
What types of injuries are possible at the parenchyma
Concussion contusions laceration diffuse axonal injury subarachnoid hemorrhages intraparenchymal hemorrhage is
What is the consequence of the concussion in parenchymal injury
Alteration in consciousness
transient neurological dysfunction
loss of consciousness and reflexes
Recovery follows but amnesia and other neuropsychiatric disorders may occur
What can cause a contusion of the parenchyma
Direct parenchymal injury from force ,vascular Disruption ,and edema
What are the main susceptible sites to contusion in the parenchyma
Crest of gyri
direct impact to rough bony surfaces, frontal lobe, orbital gyri, Temporal lobes , along fracture ends
Type of head injury causing contusion to the parenchyma
Coup injury
Contre coup at opposite
Which part of the brain the Parenchyma are affected by diffuse axonal injury
Different regions around corpus callosum
paraventricular and hippocampus
brainstem
cerebral peduncle
What secondary damage can occur after injury
Traumatic vascular injury with epidural subdural subarachnoid or intraparenchymal hemorrhages
Epidural hematoma
What type of fracture cause secondary damage
Skull fractures
Main artery affected by secondary damage
Middle meningeal artery
What are the different types of intracranial Hematoma
Extradural hematoma
subdural hematoma
intra-cerebral hematoma
burst lobe
Main cause of extradural hematoma
Complication of skull fracture
Main artery involved in extradural hematoma
Middle meningeal artery
Which type of hematoma do you have in small amounts after any head injury
Subdural hematoma
person more at risk of chronic subdural hematoma
Elderly
What is subdural hygroma
Collection of cerebrospinal fluid without blood under dura which are mostly derived from chronic subdural hematoma’s
Seen mostly in elderly after minor trauma or children after infection
Main cause of intracerebral hematoma
Contusions or basal ganglia hematoma
What is a burst lobe
Combination of subdural hematoma ,cerebral contusion and intracerebral hematoma
Consequence of intracranial hematoma
Siri edema brain swelling Brain damage if increased intracranial pressure Infection Fats embolism Brain damage if hypoxia
Where does blood collect in subdural hematoma
Between inner surface of dura and outer surface of arachnoid
In which patient is subdural hematoma common
Elderly patient with Atrophic brain minor trauma
Which hemisphere does the bloods collect in subdural hematoma
Lateral hemisphere and may be bilateral
Main cause of non-missile spinal injury
Subluxations and fracture /dislocation
Missile cause of spinal injury
Bullets or missiles
Stab wounds