neuropathology of head trauma Flashcards by Jessica Buddenbaum

Trauma is the____ leading cause of death in the USA.

fifth

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Trauma is the leading cause of death in persons under _____ of age.

44 years

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Traumatic brain injury (TBI) is a contributing factor in _____of all trauma-related deaths.

a third

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Approximately __% of the US population (~5 million people) living with long term disabilities as a consequence of a TBI

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mechanical damage occurring at the moment of impact

primary brain injury

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primary brain injury may also cause secondary effects effects via ______ due to ___________

secondary brain injury due to mass lesions, brain swelling, cerebral ischemia, infection, etc

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Traumatic brain injury (TBI) may be caused by ______ or by______ forces.

impact forces - inertial forces

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examples of inertial forces

acceleration, deceleration, rotational forces

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mechanical strain, stretching or shearing of axons

diffuse axonal injury

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inertial forces like a car accident can cause diffuse injury of ____ and ____. This can lead to __________

diffuse injury of axons and blood vessels - this can lead to diffuse brain injury

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closed head injury

non-penetrating head trauma) from blunt force injury (contact injury)

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is closed or penetrating head trauma more common?

closed heady injury

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label the types of hemorrhages

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epidural hematoma

A blood clot located between inner table of skull and dura mater in the epidural space.

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most epidural hematomas are associated with a skull fracture and tearing of a meningeal ______ usually the ________

artery, the middle meningeal artery

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epidural hematoma is usually associated with a _____ accident, ____ or _____

motor vehicle accident, fall, or assault

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an epidural hematoma from torn artery grows quickly, causing______ and the potential for_____ herniation

mass effect

transtentorial

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talk and die syndrome

About 25% of patients have a short “lucid interval” before lapsing into coma from the mass effect

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between the ____ table and _____ is an epidural hematoma

inner table and dura matter

( between dura matter and bone)

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describe this

epidural hematoma - lens shape

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subdural hematoma

Blood clot located in potential space between dura and arachnoid. Normally, this space is occupied by the layer of dural border cells.

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subdural hematoma is commonly due to tearing of a _____ by inertial forces

bridging vein

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May also be due to laceration of a small leptomeningeal artery associated with an underlying brain contusion

subdural hematoma

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May also occur after minor or unrecognized head injury in patients with predisposing factors

subdural hematoma

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type of hematoma that is most common

subdural

subdural hematoma resulting in the Mass effect may be sufficient to cause _______ and transtentorial herniation

midline shift

onsent of acute subdural hematoma (SDH)

becomes symptomatic within 3 days of trauma

subacute subdural hematoma becomes symptomatic between _____ days and _____ of trauma

3 days and 3 weeks of trauma

onsent of chronic SDH

becomes symptomatic beyond 3 weeks after trauma

what is this

subdural hematoma

Chronic SDH is due to the failure of resorption of an acute SDH. The persisting hematoma becomes encapsulated by\_\_\_\_\_\_\_\_\_\_\_over a two–week period.

fibrovascular membranes

predisposing factors for chorinic subdural hematoma

Age-related brain atrophy, alcoholism, coagulopathy, and over-drainage of CSF by a VP shunt are predisposing factors.

Hematoma enlarges due to \_\_\_\_\_\_\_\_—may see old and new hemorrhage on CT scan.

re-bleeding

50% of patients recall no head trauma in this type of hemorrage

subarachnoid hemorrhage (SAH) usually accompanies ____ head injury

significant

most common cause of subarachnoid hemorrhage

head trauma

what is this image

intracerebral hemorrhage

A _______ is a cortical hemorrhage resulting from the surface of the brain making contact with the bony protuberances of the base of the skull.

contusion

A variable amount of brain necrosis ______ accompanies the brain hemorrhage

(contusion necrosis)

Remote contusions are evidenced grossly by \_\_\_\_\_-stained areas of cortical atrophy.

hemosiderin

favored sites for brain contusions

- Inferior frontal gyri, frontal and temporal poles, and the cortex above and below the Sylvian fissures - Crests of the gyri are characteristically preferentially involved by contusions.

\_\_\_\_\_ contusions are defined as those beneath the site of impact.

“Coup”

\_\_\_\_\_\_ contusions are defined as those opposite the site of impact.

“Contrecoup”

Coup contusions are more common with a \_\_\_\_\_\_\_

blow to the head

Contrecoup contusions are more common with a\_\_\_\_\_\_\_

fall

diffuse axonal injury

is due to widespread “shearing” of axons caused by an acceleration/deceleration injury.

Most common cause of coma following a traumatic brain injury

diffuse axonal injury

brain edema

•increases the ICP and magnifies any mass effect

Raised intracranial pressure (ICP) decreases _______ and may cause global brain ischemia

cerebral perfusion pressure

Mass lesions may cause brain ____ and death

herniation

Secondary effects of brain injury

* Brain edema → increases the ICP and magnifies any mass effect * Raised intracranial pressure (ICP) → decreases cerebral perfusion pressure and may cause global brain ischemia * Mass lesions → may cause brain herniation and death * Ischemic brain injury — from systemic hypotension, raised ICP, etc. * Infection — leptomeningitis or brain abscess from penetrating injury * Post-traumatic epilepsy * Chronic traumatic encephalopathy

clinical picture of chronic traumatic encephalopathy

* Emotional lability * Personality change * Memory impairment * Dementia * Pyramidal and extrapyramidal dysfunction * Cerebellar impairment

microtubule associated protein, thought to be related to axonal disruption

Tau

chronic traumatic encephalopathy: Distinct perivascular accumulation of ____ protein in depths of sulci in neocortical gray matter

Tau

microscopic features of CTE chronic traumatic encephalopathy

- abnormal accumulation of hyper phosphorylated tau - amyloid B - transactive response DNA binding protein 43

Macroscopic findings of chronic traumatic encephalopathy

»Atrophy in cerebral hemispheres and cerebellum

chronic traumatic encepahloathy lobes preferentially affected

Temporal and frontal lobes

Infant presents with triad of acute encephalopathy, subdural hematoma(s), and \_\_\_\_\_\_\_\_\_\_

retinal hemorrhages

\_\_\_\_\_\_ is the leading cause of traumatic death in infants.

•Abusive head trauma

Also known as “shaken baby syndrome,” “shaken-impact syndrome,” “inflicted traumatic brain injury, ” or “non-accidental head trauma in infants”

abuse head trauma in infants

If child survives shaken baby syndrome they maybe have

cognitive, language, motor, visual, and learning deficits

fractures of the skull vault are ____ common than those of the skull base

skull base fracture

basilar skull fracture

Battle's sign suggest

basilar skull fracture

Complications of a calvarial skull fracture

- Depressed skull fragments may cause contusion of underlying brain (fracture contusion) - Fracture may tear the middle meningeal artery in the dura mater, resulting in an acute epidural hematoma

Complications of a basilar skull fracture

- CSF leak from nose (rhinorrhea) or ear (otorrhea) and the associated risk of meningitis - Risk of tearing a cranial nerve or the pituitary stalk