Pathology of head injury Flashcards
cOOMON CAUSES OF HEAD INJURY
RTA/trauma
What is the primary insult? What would b the secondry insuls?
Primary = the actual brain trauma
Secondary insult = things that can happen outside of brain as a result
-hypotension
-hypoxia
-infection
-haematoma
GCS scale severity : mild/moderate/severe
Mild = 13-15
Moderate = 9-13
Severe = coma = 3-8
What is enceohalitis?
infection of the brain itself, so like meningitis is infection and inflammation of the meninges, encephalitis is of the brain
P in SCALP
Periosteum
In what meinges can blood vessels be found?
in Arachnoid mater
WHich meninges are “stuck” together?
Dura and arachnoid
Why do we get a lot of lacerations on head?
because not much scope for movement, so skin tears easily, often in clean lines
Laceration vs inscised
laceration = from tearing
Incised = from sharp injury
What is a hinge fracture?
A linear fracture (commonly temporo-parietal) that continues to the skull base
What type of fractures cause infection
Depressed fracture, because the bone is broken it is a easy route in for pathogens.
Also risk of post traumatic epilepsy
What is a ring fracture? What can cause it?
A fracture around the foramen magnum
Often due to sudden decellaration injuries, eg fall from height and landing on feet. due to brainstem impact on the base of hte skull
What is a contra- oup fractue?
When the back of the head is hit, but it is the front of the skull that fractures (thinner)
What is coning?
Raised ICP forcing the brianstem out of the skull through the foramen magnum.
Msot common cause of extradural haemorrhage?
MMA (middle meningeal) artery
Subdural commonly caused by which veins shear and tear? Who seen in most and why?
Bridging veins.
Rotational/”shearing” force can cause veins to stretch and tear.
More common in alcoholics and elderly as brian shrinks and so the veins already might be stretched to a degree.
Can Sub dural be mistaken fro dementia?
Yes, if occurs in eldery, because it can stop bleeding and because of the shrunken brain, it has the space to occupy but still cause neuronal damage.
Extradural vs sub dural lucid intervals
Extradural is much shorter because it is an artery and so pumping more blood, so dramatic downturn is very fast.
Subdural is longer because it comes from veins.
Sub arachnoid haemorrhage, SAH most common cause? In trauma also due to what?
Berry Aneurysms.
In trauma seen with BRUISING, and too fast movement from side to side, causeing shearing of the vertibro-basillar artery, but the reason death is so quick os because of shearing of the brainstem (we think)
What are contusions?
Direct mechanical damage to brain
contracoup injuries
Damage on Opposite side to impact
What is Traumatic diffuse axonal injury?
Caused by vigourous shaking kinda, although not only caused by trauma. Axonal injury all around the brain.
What might you see to indicate diffuse axonal injury? Where are the more likely to appear (axonal injury)
In the blood vessles, - diffuse vascular injury would point you i the right direction.
Most likely to appear in corpus callosum, para-saggital white matter, internal capsule and dorsolateral aspects of brainstem and cerebellar peduncles.
In fatalietits, what is often the common cause of death?
Raised ICP causing compression of the brainstem and tonsils andd eventual vital functions from the brainstem are cut off.
