Pathology 2.17

Question 1

What is the difference between concussion and contusion?

Answer 1

concussion:

• mild force
• no morhologic findings in brain

contusion:

• more severe signs
• possible complications leading to coma and death

Question 2

What is the definition of concussion?

Answer 2

“a clinical syndrome due to mechanical, usually traumatic, forces characterized by immediate and transient impairment of neural function, such as alteration of consciousness, or disturbance of vision and equilibrium”

Question 3

How long does a concussion usually last?

Answer 3

less than 6 hours

Question 4

What is a cerebral contusion?

Answer 4

-bruise of cortical surface of brain from head trauma

Question 5

What is a coup contusion?

Answer 5

type of cerebral contusion which occurs at point of impact

Question 6

What is a contra-coup contusion?

Answer 6

type of cerebral contusion from backwards fall where abrasions prone to occur on contralateral side of brain opposite point of contact

Question 7

What is the physiology of contusions?

Answer 7

• occipital bone hits againts cerebrum
• gelatinous cerebral tissue recoils and permits motion
• frontal and temporal poles hit against irregular, rough surface of ant. and middle cranial fossae at base of skull

Question 8

How can contusions be classified morphologically?

Answer 8

minimal: limited to cortex and restricted to apex of gyri
larger: destroy large areas of cortex, expand into white matter; hemorrhage and edema create mass lesion with possible herniation and death

Question 9

Are contusions permanent?

Answer 9

yes

Question 10

How do contusions heal?

Answer 10

• bruised, necrotic tissue rapidly phagocytized by macrophages
• mild astrocytic proliferation forms local scar (gliosis)
• lesion finally ends up a pigmented crater

Question 11

Where are contusions most prominent?

Answer 11

inferior and lateral aspects of cerebral hemispheres

Question 12

What causes brain herniations?

Answer 12

• due to increased intracranial pressure
• cerebral edema, hydrocephalus
• focal tumors, abscesses, hemorrhages

Question 13

What is the clinical presentation of brain herniations?

Answer 13

massive headache

vomiting

Question 14

What is a subfalcine herniation?

Answer 14

cingulate gyrus herniation;

• asymmetrical expansion of cerebral hemisphere displaces cingulate gyrus under falx
• causes compression of brances of anterior cerebral artery

Question 15

What is a tonsillar herniation?

Answer 15

• displacement of cerebellar tonsils through foramen magnum
• causes compresion of cardiac and respiratory centers
• leads to death
• called “Coning”

Question 16

What is a transtentorial herniation?

Answer 16

• medial aspect of temporal lobe (hippocampus) is compressed against free margin of tentorium cerebelli
• causes compression of CN III with pupillary dilation and impairment of ocular mvmts on ipsilateral side

Question 17

What is a duret hemorrhage?

Answer 17

• progression of transtentorial herniation often accompanied by irreversible necrotic and hemorrhagic lesions in midbrain and pons
• due to compression of vasculature
• linear or flamed-shaped lesions which usually occur in midline of brainstem