L6 Traumatic Vascular Injury

Question 1

Brain injury at the site of impact ?

Answer 1

Coup injury

Question 2

Site of impact on the other side of the brain injury ?

Answer 2

Contrecoup injury

Question 3

Contusion in (Traumatic Parenchymal Injury) Caused by

Answer 3

• Rapid tissue displacement
• Disruption of vascular channels
• Subsequent hemorrhage
• Tissue injury
• Edema

(Both coup and contrecoup lesions are contusions)

Question 4

In Traumatic Parenchymal Injuries
Penetration of the brain by a projectile such as a bullet or a skull fragment from a fracture causes a :

Answer 4

laceration, with tissue tearing, vascular disruption, and hemorrhage.

Question 5

Traumatic Parenchymal Injuries MORPHOLGY

Answer 5

1- wedge-shaped widest aspect ( base ) closest to site of impact

2-blood extravasates cerebral cortex > white matter > subarachnoid spaces

3-injury in the neuronal cell body
(nuclear pyknosis, cytoplasmic eosinophilia, cellular disintegration) 24h

4-inflammatory response neutrophils before macrophages

Question 6

Old traumatic lesions are?

Answer 6

depressed, retracted, yellowish brown patches involving the crests of gyri

Question 7

In old contusions ther is ?

Answer 7

gliosis and residual hemosiderin-laden macrophages predominate

Question 8

More extensive hemorrhagic regions of brain
trauma give rise to ?

Answer 8

larger cavitary lesions

> > which can resemble remote infarcts.

Question 9

Diffuse axonal injury

Answer 9

1-movement of one region of brain relative to another

2- Angular acceleration, ( even in absence of impact) led to&raquo_space;>

3-axonal injury as well as hemorrhage.

4- 50% of patients develop coma shortly after trauma
have white matter damage & diffuse axonal injury

Question 10

Concussion:

Answer 10

1- reversible altered brain function
2- Due to head injury
3- with or without consciousness
4-transient neurologic dysfunction includes loss of consciousness, temporary respiratory arrest, and loss of reflexes.
5-Neurologic recovery is complete but amnesia for the event persists.
6-Repeated episodes of concussion may result in
cognitive impairment, parkinsonism and neurodegenerative diseases

Question 11

Types of Traumatic Vascular Injury?

Answer 11

• Epidural
• Subdural
• Subarachnoid
• Intraparenchymal

Question 12

most often occur at sites of contusions and lacerations ?

Answer 12

• Subarachnoid
• Intraparenchymal

Question 13

middle meningeal artery ( traumatic injury) occur usually in case of?

Answer 13

Epidural Hematoma

Question 14

Epidural Hematoma

Answer 14

1-patients can be lucid for hours between the moment of trauma and the development of neurologic signs.

-blood accumulating under arterial pressure can dissect the dura away from the inner skull surface producing a hematoma that compresses the brain surface.

Question 15

Rapid movement of the brain during traum led to damage in bridging veins and its called:

Answer 15

Subdural Hematoma

Question 16

Subdural Hematoma :

Answer 16

-In patients with brain atrophy the bridging veins are stretched out and the brain has additional space within which to move,

-accounting for the higher rate of subdural hematomas in elderly persons.

Infants are susceptible to subdural hematomas because their bridging veins are thin-walled

-manifest within the first 48 hours after injury

Question 17

Hemorrhage most common over the lateral aspects
of the cerebral hemispheres and may be bilateral?

Answer 17

Subdural Hematoma

Question 18

Neurologic signs in Subdural Hematoma are attributable to?

Answer 18

the pressure exerted on the adjacent brain

Question 19

Symptoms in Subdural Hematoma may be localizing but more often are-non-localizing taking the form of?

Answer 19

• Headache
• Confusion
• Slowly progressive neurologic deterioration.

Question 20

Morphology of Subdural Hematoma ?

Answer 20

• An acute subdural hematoma appears as:
collection of freshly clotted blood apposed to the contour of the brainsurface

• The underlying brain is flattened and the subarachnoid space is often clear

• Subdural hematomas organize by:
1- Lysis of the clot (about 1 week)

2- Growth of granulation tissue from the dural surface into the hematoma (2 weeks)

3- Fibrosis (1 to 3 months).

Question 21

Cerebral Palsy

Answer 21

1- nonprogressive neurologic motor deficits
2- spasticity, dystonia, ataxia or athetosis and paresis attributable to injury occurring during the prenatal and perinatal periods
• Signs and symptoms may not be apparent at birth

Question 22

Perinatal Brain Injury

Answer 22

1-two major types of injury that occur in the perinatal period are hemorrhages and infarcts

2- premature infants there is an increased risk of intraparenchymal hemorrhage within the germinal matrix, most often adjacent to the (anterior horn of the lateral ventricle)

3- Hemorrhages may involve subarachnoid space also causing hydrocephalus

4-Infarcts may occur in the supratentorial periventricular white matter (periventricular leukomalacia), especially in premature babies.

Question 23

most frequent type of CNS malformation?

Answer 23

Neural Tube Defects

Question 24

Neural Tube Defects include ?

Answer 24

1. Spina bifida
2. Myelomeningocele
3. Encephalocele
4. Anencephaly

Question 25

Neural Tube Defects:

Answer 25

Most common malformation
genetic component
Folate deficiency
elevated α-fetoprotein (early detection)

Question 26

-asymptomatic bony defects
-flat, disorganized segment of spinal cord associated with an overlying meningeal outpouching?

Answer 26

1. Spina bifida occulta

Question 27

-extension of CNS tissue through a defect in the vertebral column

-most commonly in the lumbosacral. region.

-Patients have motor and sensory deficits in the lower extremities and problems with bowel and bladder control

-abnormal spinal cord segment and compounded by infections extending from the thin , ulcerated overlying skin.

Answer 27

Myelomeningocele

Question 28

meningocele applies when there is only?

Answer 28

meningeal extrusion

Question 29

-diverticulum of malformed brain tissue extending through a defect in the cranium
- It most often occurs in the posterior fossa?

Answer 29

Encephalocele

Question 30

malformation of the anterior end of the neural tube, with absence of most of the brain and calvarium?

Answer 30

Anencephaly

Question 31

Microencephaly?

Answer 31

volume of brain is small
following conditions are with this condition:
1. Chromosome abnormalities
2. Fetal alcohol syndrome
3. Human immunodeficiency virus 1 (HIV-1) infection acquired in utero
4. Zika virus infection acquired in utero