Pathology of Head Injury Flashcards
What are the commonest cause of head injury?
- Road traffic accidents
- Alcohol-related incidents including assaults
What are the different kinds of head injury?
- Primary insult
- Focal and/or diffuse brain trauma
- Secondary insult
- Hypotension (low arterial BP)
- Hypoxia (low blood oxygen)
- Infection
- Haematoma (bleeding in/around the brain)
What are examples of primary head injury?
- Focal and/or diffuse brain trauma
What are examples of secondary head injuries?
- Hypotension (low arterial BP)
- Hypoxia (low blood oxygen)
- Infection
- Haematoma (bleeding in/around the brain)
How can skull fractures lead to infection?
Allows bacteria in
What is done for the initial assessment for someone with a head injury?
- Conscious level assessed using Glasgow Coma Scale
- Scored out of 15 (15 is fully conscious)
- 13-15 is mild injury
- 9-12 is moderate injury
- 3-8 in severe injury
What does GCS stand for?
Glasgow coma scale
What are the 3 kinds of injury on the GCS?
Mild
Moderate
Severe
What score on the GCS in mild?
13-15
What score on the GCS in moderate?
9-12
What score on the GCS in severe?
3-8
What are significant consequences of head injury?
- Permanent physical disability
- Post traumatic epilepsy
- Intracranial infection
- Psychiatric illness
- Chronic subdural haemorrhage
- ‘Punch drunk’ dementia
- Fatal outcome (uncommon)
What is the relationship between forensics and head injury?
- Head injuries can result from
- Accidental, homicidal and sometimes suicidal incidents
- Accidents very common, such as falls and road traffic collisions
- Homicidal may be consequence of being struck by a weapon or from a fall sustained as part of an insult
- Natural disease can also occur causing collapse with a resulting head injury
What is the head composed of?
- Scalp
- Hair-bearing skin
- Connective tissue
- Aponeurotic fascia
- Loose connective tissue
- Pericranium
- Skull
- Outer and inner “tables” of compact bone separated by spongy bone
- Meninges
- Dura mater (dense, tough, fibrous, adherent to inner surface of the skull)
- Arachnoid mater (delicate, transparent, envelopes in brain)
- Pia mater (delicate, applied to the brain surface)
- Brain
- Cerebrum
- Cerebellum
- Brainstem
- Contains vital centres providing neurological control of
- Spinal cord
What are the different layers of the scalp?
- Hair-bearing skin
- Connective tissue
- Aponeurotic fascia
- Loose connective tissue
- Pericranium
What are the 3 layers of the meninges?
- Dura mater (dense, tough, fibrous, adherent to inner surface of the skull)
- Arachnoid mater (delicate, transparent, envelopes in brain)
- Pia mater (delicate, applied to the brain surface)
What are the different parts of the brain?
- Cerebrum
- Cerebellum
- Brainstem
- Contains vital centres providing neurological control of
- Spinal cord
What are different kinds of scalp injuries?
Similar to those that can affect the skin, such as:
- Abrasions
- Bruises
- Lactations
- Incisions
- Burns and scalds
Why is the scalp a common site for laceration?
Common site for laceration because it is closely applied to the skull and tearing is more likely to occur in these circumstances
What does the skull do?
Encases the brain and its membranous coverings (meninges) apart from the foramen magnum
What do skull fractures cause?
Skull fractures cause deformation of the skull, adult skulls are less able to cope with distortion that those of infants
What are the 2 elements of the skull?
- Skull vault (upper part)
- Includes frontal bone, squamous temporal bones and occipital bone which are separate by sutures
- Skull base (upon which the brain rests)
- Divided into anterior, middle and posterior cranial fossa
What is the skull vault composed of?
- Includes frontal bone, squamous temporal bones and occipital bone which are separate by sutures
What is the skull base divided into?
- Divided into anterior, middle and posterior cranial fossa
What are the different kinds of skull fractures?
- Linear
- Commonly temporo-parietal blow or fall onto side or top of head
- Depressed
- Focal impact may push fragments inwards to damage meninges, blood vessels and the brain
- Risk of meningitis and post-traumatic epilepsy
- Comminuted (mosaic)
- Fragmented skull
- Ring fracture
- Fracture line encircling the foramen magnum caused by a fall from height, usually langing on the feet
- “Contre coup” fracture
- Fracturing of the orbital plates (anterior fossa) caused by a fall onto the back of the head
What commonly causes a linear skull fracture?
- Commonly temporo-parietal blow or fall onto side or top of head