Neuro trauma Flashcards
Location of diffuse axonal injury bleeds in order ?
- Subcortical white matter
- Posterior limb internal capsule
- Corpus callosum
- Dorsolateral midbrain
Common causes of subarachnoid hemorrhage
- Traumatic
- Aneurysm rupture
AVM, perimesencephalic venous hemmorhage, ruptured dissecting aneurysm, hypertensive hemmorhage, cerebral infarction with reperfusion hemmorhage, anticoagulation therapy, blood dyscrasia, eclampsia, spinal vascular malformation
Segments of the carotid
1 - Cervical Segment 2 - Petrous 3 - Lacerum 4 - Cavernous 5 - Clinoid 6 - Ophthalmic (supraclinoid) 7 - Communicating (terminal)
Segments of Vertebral Artery
V1 - origin to transverse foramen of C6
V2 - transverse foreman of C6 to transverse foreman of C2
V3 - C2 to dura
V4 - Dura to confluence of basilar artery
Risk factors for dissection
Fibroelastic thickening Fibromuscular hyperplasia Cystic medial degeneration Marfan Syndrome Ehlers-Danlos Homocystinuria Loeys-Dietz Syndrome Syphilis
Most common location for intracranial dissection
Supraclinoid carotid
What are the types of occipital condyle fractures and which is unstable?
1 - impaction injury with no displacement - stable
2 - skull base fracture extending through occipital condyle - stable
3 - avulsion fracture - unstable due to tension on alar ligament
What is a Jefferson Fracture?
Burst fracture through C1 fracuture bilateral posterior arch or single unilateral anterior arch.
Results in outward displacement of lateral masses.
What are finding of posterior ligamentous complex instability on CT?
Inferred on CT by: Splaying of spinous processes avulsion fracture of superior or inferior aspects of contiguous spinous processes Widening of facet joints Empty/Naked facet joints perched or dislocated facet joints vertebral body translation or rotation
What is the classification of Odontoid fractures and their stability?
Type I - tip of dens. uncommon. Fuse well with immobilization. Stable.
Type II - Fracture at the Dens-body junction. Most common. Risks for instability - Age >50, >6mm displacement, comminution or splinter fragments.
Type III - Fracture line extends through cancellous portion of C2 body. Potentially unstable. Heal with immobilization usually.
What is a hangman fracture and mechanism?
Bilateral traumatic pars interarticularis fracture resulting in spondylolysis.
Mechanism either compressive hyperextension or distractive flexion.
Classification of Hangman #’s
Type 1 - 11 degrees, >2mm translocation. variable stability
Type 2a - severe angulation without translocation. intact anterior longitudinal ligament.
Type 3 - bilateral facet dislocation - UNSTABLE
What is atlanto-axial subluxation?
Anterior facet of C1 fixed on facet of C2 causing impaired rotation.
Types of blunt cervical vascular injuries
Minimal intimal injury Raised intimal flap Dissection with intramural hematoma Occlusion Pseudoaneurysm Transection with active hemorrhage Arteriovenous fistula
What is a chance fracture
Vertebral fracture through all 3 columns. Most common at thoracolumbar junction. Mechanism commonly flexion and distraction.
