L5: Head Injury Flashcards
1
Q
what do head injuries include?
A
- Scalp injuries.
- Skull injuries.
- Brain injuries.
- Intracranial hemorrhage
2
Q
Characters of Scalp injuries
A
- Wounds of scalp may or may not be associated with fracture of the skull and/or injuries to the intracranial contents.
- In case of trauma over top of head or the forehead, extravasated blood may gravitate down to loose tissue Causing black eye “periorbital hematoma”.
2
Q
Complications of Scalp injuries
A
- Severe bleeding
- Tetanus or erysipelas infection
- Intracranial infection
3
Q
Intracranial infection in Scalp injuries
A
It may readily spread from scalp to brain through emissary veins or fissured skull underlying wounds, resulting in:
- Traumatic meningitis
- Encephalitis
- Brain abscess
- Sinus thrombosis.
3
Q
Severe bleeding in Scalp injuries
A
Bleeding occurs because of rich blood supply of scalp and its leathery texture which prevents recoil of cut ends of vessels.
4
Q
Types of Skull Injuries
A
4
Q
Definition of Fissure Fracture
A
- It is a linear crack passing over vertex or across skull base without any displacement of fragments, either involves whole thickness of bone or inner or outer table alone.
5
Q
Causes of Fissure Fracture
A
6
Q
Characters of Fissure Fracture
A
7
Q
What are another names of Comminuted Fracture?
A
“Spider Web” or “Mosaic Fracture”
8
Q
Cause of Comminuted Fracture
A
9
Q
Definition ofLocalized Depressed Fracture
A
- When a portion of fractured bone is driven inwards, it is known as depressed fracture.
9
Q
Characters of Comminuted Fracture
A
- Skull bone is depressed, gets broken into multiple pieces by fracture lines that radiate from site of impact. (Radiating fissure fractures)
9
Q
Cause of Localized Depressed Fracture:
A
10
Q
Characters of Localized Depressed Fracture:
A
11
Q
What is Pond Fracture (Ping Pong Fracture)?
A
12
Q
Cause of Cut Fracture
A
13
Q
Characters of Cut Fracture
A
14
Q
Gutter fracture
A
15
Q
Cause of Penetrating Fracture
A
15
Q
What are factors that govern fracture of the skull?
A
- Momentum of the force
- Size and shape of the striking surface
- Site of the blow
- The mobility of the head at the time of the blow
- Elasticity of the bone
- Whether the trauma is direct or indirect
16
Q
Momentum of the force
Factors governing fracture of the skull
A
17
Q
Size and shape of the striking surface
Factors governing fracture of the skull
A
17
Q
Site of the blow
Factors governing fracture of the skull
A
18
The mobility of the head at the time of the blow
**Factors governing fracture of the skull**
18
Elasticity of the bone
**Factors governing fracture of the skull**
18
Whether the trauma is direct or indirect
**Factors governing fracture of the skull**
19
Incidence of **Basal Fractures**
- These are more common than fractures of vault, because base is less elastic and is weakened by presence of multiple foramina.
20
Characters of **Basal Fractures**
- They are usually fissured fractures.
- These fractures may be missed on X-ray examination.
21
Causes of **Basal Fractures**
22
Sites of **Basal Fractures**
- Fracture of anterior cranial fossa
- Fracture of middle cranial fossa
- Fracture of posterior cranial fossa
- Ring fracture
23
Fracture of anterior cranial fossa
- Manifested by escape of blood & CSF from nose.
- As well as sub-conjunctival hemorrhage or black eye, (Due to extravasation of blood in the orbit).
24
Fracture of middle cranial fossa
- Manifested by escape of blood & CSF from ear, sometimes nose
- Through Eustachian tube
24
Fracture of posterior cranial fossa
Manifested by escape of blood & CSF into tissues of neck
25
Ring fracture
Caused by:
- Indirect violence transmitted through vertebral column se.g., falls from a height on feet or buttocks.
- Severe blow on vortex which drive skull downwards onto spinal column.
26
A blow on the chin may result in .....
fracture of glenoid fossae
27
The force of a blow on mandible as boxing may be transmitted through maxilla and its internal angular processes to base of skull resulting in ......
fracture of cribriform plate of ethmoid bone
28
Complications of **Basal Fractures**
29
Types of **Brain Injuries**
Open Head Injury: Penetrating wounds of the head.
Closed Head Injury: Application of blunt force, whether the skull is fractured or not (Commonest)
30
Injuries to the brain result in ......
- Brain concussion.
- Contusion and laceration of the brain substance.
- Compression of the brain.
31
Def of **Brain Concussion**
- It is a clinical state of sudden momentary loss of consciousness following head injuries.
- It is characterized by momentary physiological disruption of the function of brain with little or no noticeable anatomical changes.
32
Mechanism of Brain Concussion
Loss of consciousness may be due to
- Rotational injury affecting the brain stem
- Generalized vibratory wave affecting brain stem reticular formation which is responsible for normal consciousness state of individual.
33
Signs & Symptoms of Brain Concussion
34
Lab & Rad findings in **Brain Concussion**
CT and MRI scans: Usually normal.
35
Fate of **Brain Concussion**
1. Complete recovery "uncomplicated concussion"
2. Incomplete recovery
3. Concussion passes to compression
4. Death "rare"
36
Complete recovery "uncomplicated concussion"
- In cases of simple concussion which is not accompanied by structural damage of brain, Victim may complain of headache and may be restless.
- Complete recovery occurs within few hours (about 6 hours) with no residual signs.
37
Retrograde amnesia in Brain concussion
**Retrograde amnesia:** forgets moment of trauma and period of time preceding
37
Incomplete recovery in concussion
Recovery may be followed by Post-Concussion Syndrome. "PC" which is characterized by:
- Headache
- Vertigo
- Insomnia
- Mental irritation
- occasional impairment of memory (Loss of concentration).
- Retrograde amnesia.
- Post-traumatic automatism.
38
Post-traumatic automatism in brain concussion
- The patient may do voluntary acts after the accident, but he forgots overything about what he did. **(He is not responsible legally)**
- In this case, there may be secondary. changes such as Agliosis or degoneration of cerebral tissues.
39
Types of compression after Brain concussion
- Concussion passes to compression With Lucid Interval
- Concussion passing directly into compression Without Lucid Interval
40
Concussion passes to compression With Lucid Interval
In some cases of head injuries,
- there is an initial recovery (for a variable period) from symptoms of concussion
- followed by loss of consciousness due the increase of intracranial tension (compression).
This period of apparent recovery is called "lucid interval".
41
Concussion passing directly into compression Without Lucid Interval
In cases of
- Depressed bone
- Extensive meningeal hemorrhage.
42
Death due to concussion
In severe cases of concussion,
- Shock may be sufficient to inhibit vital processes and causes death.
43
Def of **Lucid Interval**
Period of temporary recovery between unconsciousness state of concussion and that of compression.
44
Characters of **Lucid Interval**
The patient may be able to walk to home unaided, speak sensibly and tell the events.
45
Cause of **Lucid Interval**
**It is common with**
- Injury of middle meningeal artery. or one of its branches (extradural hemorrhage) Where,hematoma takes some time to attain a sufficient size to separate
dura from the bone and to produce compression.
- It occurs also with subdural hemorrhage.
46
Mechanism of **Lucid Interval**
47
Duration of **Lucid Interval**
Few minutes, hours, or even few days according to size of ruptured vessel.
48
MLI of **Lucid Interval**
49
when is a decompression operation required?
indicated when pulse slows down to 60/minute.
50
Lesions in brain compression are localized by .....
- Condition of pupils
- Reflexes
- Signs of localization (signs of lateralization)
- CT scan but not by site of wound in scalp.
51
Def of **Contusions and lacerations to the brain**
- Areas of hemorrhagic disruption (tearing lesions) of CNS that are superficially located in brain are called
Contusions if the pia mater is intact.
Lacerations if the pia is torn
52
Charactesr of **Contusions and lacerations to the brain**
- Injuries are often associated with hemorrhage into subarachnoid space,
- Lesions may be on same side as site of violence (coup injury) or directly opposite to it (contre-coup injury).
- They are common in boxers.
53
what is a **coup injury**?
It is one which occurs immediately subjacent to area of impact (Blow)
54
What is a **Conte-Coup injury**?
- It is situated on contralateral side of area of impact
- It can occur only if head is free to move.
- It is due to sudden stoppage of movement of head by coming in contact with a hard substance on opposite side, causing development of linear & rotational strains producing injury opposite to site of impact.
55
Def of **Cerebral compression**
- Clinical condition caused by increased intracranial pressure (inside rigid boundaries of skull) which disturbs functions of brain, leading to gradual loss of consciousness.
56
Traumatic Causes of **Cerebral compression**
- Depressed fracture of skull bone.
- Traumatic intracranial hemorrhage.
57
Mechanism of **Cerebral compression**
58
Causes of death in Cerebral compression
- Death may occur from paralysis of vital centers (asphyxia), as more pressure will push brain substance leading to herniation of medulla through foramen magnum (Herniation Syndromes).
59
CP of **Cerebral compression**
60
Signs of lateralization in Cerebral compression
- Pupils
- Eye Deviation
- Reflexes
61
Pupils in **Cerebral compression**
62
Eyes Deviation in **Cerebral compression**
63
Reflexes in **Cerebral compression**
64
Types of **Intracranial Hemorrhages**
- Extra-dural
- Subdural
- Subarachnoid
- Intracerebral
65
what is a common complication of head injury?
Intracranial Hemorrhages
66
what is the most common cause of death in patients who experienced a lucid interval?
Intracranial hemorrhage
67
Etiology of **Extradural (Epidural) Hemorrhage**
68
Clinical complications associated with a hematoma are related to .......
- Size/volume of lesion
- Anatomical location
- The rapidity with which it develops.
69
Incidence of **Extradural (Epidural) Hemorrhage**
- Less common
**Site:** Hematoma is found between Dura and Skull
70
MLI of **Extradural (Epidural) Hemorrhage**
- It is usually accompanied with lucid interval, so its medicolegal importance is the same as that of the lucid interval.
- In children, extradural hematoma may be seen even without skull fracture.
71
Factors affecting of **Extradural (Epidural) Hemorrhage**
The Size and extent of extradural hematoma is determined by two factors:
- The source of bleeding (venous or arterial)
- The strength of attachment between the outer layer of the dura and the cranium.
72
Incidence of **Subdural Hemorrhage**
- More common than the extradural hemorrhage
73
Etiology of **Subdural Hemorrhage**
traumatic or pathological
74
Site of **Subdural Hemorrhage**
- It occurs between under surface of dura & outer surface of arachnoid mater.
- It is essentially venous or capillary and not arterial bleeding
75
Types of Traumatic subdural Hemorrhage
76
Pathological subdural hemorrhage
It is usually an extension of subarahnoid or intracerebral hemorrhage.
77
Incidence of Subarachnoid Hemorrhage
- The commonest form of traumatic intracranial hemorrhage.
- may occur among alcoholics
78
why is Subarachnoid Hemorrhage common among alcoholics?
Due to mild blow to sido of nock which stroiches and ruptures vertebral artery, this leads to prosecution of culpable homicide rather than murder.
79
Site of **Subarachnoid Hemorrhage**
occurs between arachnoid and the pia mater.
80
Etiology of **Subarachnoid Hemorrhage**
traumatic or pathological
81
Traumatic causes of Subarachnoid Hemorrhage
- Extension of subdural hemorrhage.
- Hemorrhage after tearing of meninges.
- Rupture of bridging veins which traverse the subdural and subarachnoid spaces.
82
Pathological causes of Subarachnoid Hemorrhage
83
Etiology of **Intracerebral Hemorrhage**
either traumatic or pathological
84
Traumatic intracerebral hemorrhage
85
**Pathological intracerebral hemorrhage (Apoplexy)**
- It is due to rupture of atherosclerotic cerebral vessels in hypertensive patient, (there is no cerebral laceration).
- It is common at corpus striatum or pons
86
Manifestations of Pontine hemorrhage
- Coma
- Pinpoint pupils
- Hyperpyrexia
- Hemiplegia or quadriplegia.
87
Sequelae of head injuries
88
Causes of death in head injuries
