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neuropathology of head trauma Flashcards

1
Q

Trauma is the____ leading cause of death in the USA.

A

fifth

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2
Q

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

A

44 years

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3
Q

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

A

a third

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4
Q

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

A

2

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5
Q

mechanical damage occurring at the moment of impact

A

primary brain injury

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6
Q

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

A

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

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7
Q

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

A
  • impact forces - inertial forces
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8
Q

examples of inertial forces

A

acceleration, deceleration, rotational forces

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9
Q

mechanical strain, stretching or shearing of axons

A

diffuse axonal injury

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10
Q

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

A
  • diffuse injury of axons and blood vessels - this can lead to diffuse brain injury
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11
Q

closed head injury

A

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

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12
Q

is closed or penetrating head trauma more common?

A

closed heady injury

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13
Q

label the types of hemorrhages

A
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14
Q

epidural hematoma

A

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

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15
Q

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

A

artery, the middle meningeal artery

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16
Q

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

A

motor vehicle accident, fall, or assault

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17
Q

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

A

mass effect

transtentorial

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18
Q

talk and die syndrome

A

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

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19
Q

between the ____ table and _____ is an epidural hematoma

A

inner table and dura matter

( between dura matter and bone)

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20
Q

describe this

A

epidural hematoma - lens shape

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21
Q

subdural hematoma

A

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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22
Q

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

A

bridging vein

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23
Q

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

A

subdural hematoma

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24
Q

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

A

subdural hematoma

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25
Q

type of hematoma that is most common

A

subdural

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26
Q

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

A

midline shift

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27
Q

onsent of acute subdural hematoma (SDH)

A

becomes symptomatic within 3 days of trauma

28
Q

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

A

3 days and 3 weeks of trauma

29
Q

onsent of chronic SDH

A

becomes symptomatic beyond 3 weeks after trauma

30
Q

what is this

A

subdural hematoma

31
Q

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

A

fibrovascular membranes

32
Q

predisposing factors for chorinic subdural hematoma

A

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

33
Q

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

A

re-bleeding

34
Q

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

A
35
Q

subarachnoid hemorrhage (SAH) usually accompanies ____ head injury

A

significant

36
Q

most common cause of subarachnoid hemorrhage

A

head trauma

37
Q

what is this image

A

intracerebral hemorrhage

38
Q

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

A

contusion

39
Q

A variable amount of brain necrosis ______ accompanies the brain hemorrhage

A

(contusion necrosis)

40
Q

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

A

hemosiderin

41
Q

favored sites for brain contusions

A
  • 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.
42
Q

_____ contusions are defined as those beneath the site of impact.

A

“Coup”

43
Q

______ contusions are defined as those opposite the site of impact.

A

“Contrecoup”

44
Q

Coup contusions are more common with a _______

A

blow to the head

45
Q

Contrecoup contusions are more common with a_______

A

fall

46
Q

diffuse axonal injury

A

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

47
Q

Most common cause of coma following a traumatic brain injury

A

diffuse axonal injury

48
Q

brain edema

A

•increases the ICP and magnifies any mass effect

49
Q

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

A

cerebral perfusion pressure

50
Q

Mass lesions may cause brain ____ and death

A

herniation

51
Q

Secondary effects of brain injury

A
  • 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
52
Q

clinical picture of chronic traumatic encephalopathy

A
  • Emotional lability
  • Personality change
  • Memory impairment
  • Dementia
  • Pyramidal and extrapyramidal dysfunction
  • Cerebellar impairment
53
Q

microtubule associated protein, thought to be related to axonal disruption

A

Tau

54
Q

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

A

Tau

55
Q

microscopic features of CTE chronic traumatic encephalopathy

A
  • abnormal accumulation of hyper phosphorylated tau
  • amyloid B
  • transactive response DNA binding protein 43
56
Q

Macroscopic findings of chronic traumatic encephalopathy

A

»Atrophy in cerebral hemispheres and cerebellum

57
Q

chronic traumatic encepahloathy lobes preferentially affected

A

Temporal and frontal lobes

58
Q

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

A

retinal hemorrhages

59
Q

______ is the leading cause of traumatic death in infants.

A

•Abusive head trauma

60
Q

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

A

abuse head trauma in infants

61
Q

If child survives shaken baby syndrome they maybe have

A

cognitive, language, motor, visual, and learning deficits

62
Q

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

A

more

63
Q

skull base fracture

A

basilar skull fracture

64
Q

Battle’s sign suggest

A

basilar skull fracture

65
Q

Complications of a calvarial skull fracture

A
  • 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
66
Q

Complications of a basilar skull fracture

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

Neuro (27 decks)

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