L6 Traumatic Vascular Injury Flashcards
Brain injury at the site of impact ?
Coup injury
Site of impact on the other side of the brain injury ?
Contrecoup injury
Contusion in (Traumatic Parenchymal Injury) Caused by
• Rapid tissue displacement
• Disruption of vascular channels
• Subsequent hemorrhage
• Tissue injury
• Edema
(Both coup and contrecoup lesions are contusions)
In Traumatic Parenchymal Injuries
Penetration of the brain by a projectile such as a bullet or a skull fragment from a fracture causes a :
laceration, with tissue tearing, vascular disruption, and hemorrhage.
Traumatic Parenchymal Injuries MORPHOLGY
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
Old traumatic lesions are?
depressed, retracted, yellowish brown patches involving the crests of gyri
In old contusions ther is ?
gliosis and residual hemosiderin-laden macrophages predominate
More extensive hemorrhagic regions of brain
trauma give rise to ?
larger cavitary lesions
> > which can resemble remote infarcts.
Diffuse axonal injury
1-movement of one region of brain relative to another
2- Angular acceleration, ( even in absence of impact) led to»_space;>
3-axonal injury as well as hemorrhage.
4- 50% of patients develop coma shortly after trauma
have white matter damage & diffuse axonal injury
Concussion:
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
Types of Traumatic Vascular Injury?
• Epidural
• Subdural
• Subarachnoid
• Intraparenchymal
most often occur at sites of contusions and lacerations ?
• Subarachnoid
• Intraparenchymal
middle meningeal artery ( traumatic injury) occur usually in case of?
Epidural Hematoma
Epidural Hematoma
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.
Rapid movement of the brain during traum led to damage in bridging veins and its called:
Subdural Hematoma
Subdural Hematoma :
-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
Hemorrhage most common over the lateral aspects
of the cerebral hemispheres and may be bilateral?
Subdural Hematoma
Neurologic signs in Subdural Hematoma are attributable to?
the pressure exerted on the adjacent brain
Symptoms in Subdural Hematoma may be localizing but more often are-non-localizing taking the form of?
• Headache
• Confusion
• Slowly progressive neurologic deterioration.
Morphology of Subdural Hematoma ?
• 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).
Cerebral Palsy
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
Perinatal Brain Injury
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.
most frequent type of CNS malformation?
Neural Tube Defects
Neural Tube Defects include ?
- Spina bifida
- Myelomeningocele
- Encephalocele
- Anencephaly
Neural Tube Defects:
Most common malformation
genetic component
Folate deficiency
elevated α-fetoprotein (early detection)
-asymptomatic bony defects
-flat, disorganized segment of spinal cord associated with an overlying meningeal outpouching?
- Spina bifida occulta
-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.
Myelomeningocele
meningocele applies when there is only?
meningeal extrusion
-diverticulum of malformed brain tissue extending through a defect in the cranium
- It most often occurs in the posterior fossa?
Encephalocele
malformation of the anterior end of the neural tube, with absence of most of the brain and calvarium?
Anencephaly
Microencephaly?
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
