Lecture 22- forensic pathology of head injuries Flashcards
Types of skull fracture
Linear Depressed Contra-coup Hinge Ring Diastatic Pond- ripple/spider web
Extradural haemorrhage
Between skull and dura- results from torn vessels in meninges with skull fracture (middle meningeal artery due to fracture of squamous temporal bone)
Cerebral compresssion/ herniation > death
Lucid interval- accm. of blood normally slow, time between injury and death
Subdural haemorrhage
Between inner surface of dura and arachnoid layers- tearing of bridging veins which empty into superior saggital sinus
Brain floats in CSF but veins are fixed
^ risk in elderly, alcoholics
Normal clinical presentation within 48hrs- headache, confusion
Cerebral contusion
Superficial bruises of brain- frontal poles, orbital surfaces of frontal poles, temporal poles, cortex adjacent to sylvian fissure common areas
Coup injury- point of contact
Contrecoup- injury to surface opposite POC: sudden deceleration (car crash), indicated movement of head at injury
^ force of injury ^ risk of laceration
Traumatic subarachnoid
possible sources of bleeding include- several contusions/lacerations
skull fracture can tear vessels at base of brain, rupture if dissection of vertebral arteries
Blood from intraventricular haemorrhage
chronically may cause hydrocephalus due to blockage of CSF
Diffuse axonal injury
Widespread traumatic axonal damage
clinically- typically unconscious from moment of impact, no lucid interval and remain uncoscious, in veg. state or severely disabled
Raised intracranial pressure
Clinical features: headache, vomiting, confusion, focal neurological signs (paralysis, hemianopia, dysphasia), depressed conscious level, seizure and papilloedema
What are the effects of raised ICP?
Flattening of gyral pattern, compression of ventricle on same side as lesion
lateral shift of midline structures if lesion unilateral
Internal herniation
