Pathology of head injury

Question 1

what is the difference between primary and secondary insult?

Answer 1

primary insult is focal trauma to the brain
secondary insult is trauma to the head due to falling over etc from hypoglycaemia, hypotension, hypoxia, infection, haematoma

Question 2

what is the GCS scores that would indicate;

1. mild injury?
2. moderate injury?
3. severe injury?

Answer 2

1 = 13-15
2 = 9-12
3 = 3-8

Question 3

how is a patients the glasgow coma scale assessed?

Answer 3

eyes opening (out of 4)
verbal response (out of 5)
motor response (out of 6)

Question 4

what is the name of a fracture - caused by blunt trauma to the back of the head which causes fracturing of the orbital bone?

Answer 4

contrecoup fracture

Question 5

what is a ring fracture?

Answer 5

a fracture forming a ring around the formanen magnum
usually caused by falling from a high height and landing on the feet
causes cervical spine and base of skull to be forced together

Question 6

what is the term for a fracture causeing a fregmented skull?

Answer 6

comminuted (mosaic)

Question 7

what is the name for a fracture which is caused y focal impact which causes bone fragments to be pushed in damaging the meninges?

Answer 7

decompressed fracture

Question 8

what fracture is commonly tempero-parietal and may continue to the base of the skull (hinge fracture)?

Answer 8

linear fracture

Question 9

what is the consequence of intracranial haemorrhage?

Answer 9

raised intracranial pressure causing compression of the brain

Question 10

what is the difference in the source of extradural haemorrhage and subdural haemorrahge?

Answer 10

extra dural - arteries

subdural - veins

Question 11

what is the cause of sub dural haemorrhages?

Answer 11

high impact force which causes straining of the bridging veins

Question 12

why is it hard for clinicians to identify an intracranial haemorrhage?

Answer 12

lucid interval
patients may appear fine for a while and the blood will slowly accumulate resulting in death
it should always be considered in head trauma

Question 13

in what type of intracranial haemorrhage is there likely to be a longer lucid interval and why?

Answer 13

sub dural haemorrhage because it is due to the rupture of the bridging veins
veins are under less pressure than arteries so will bleed more slowly

Question 14

what is the main consequence of cerebral oedema?

Answer 14

coning

Question 15

what is the clinical term for bleeding?

Answer 15

contusion

Question 16

hat is the difference between coup contusion and contra-coup contusion?

Answer 16

coup contusion = bruising of the brain at the area of impact/injury
contra-coup is bleeding of the brain in the opposite side of where there was impact/force.
i.e. a hit to the front of the head causing bleeding in the back of the skull

Question 17

what can serious rotation forces applied to the brain cause?

Answer 17

traumatic diffuse axonal injury

Question 18

what is a lesser degree of diffuse axonal injury?

Answer 18

concussion

Question 19

What are the consequences of head injury?

Answer 19

Increased ICP due to oedema which can lead to coning = death 
Permanent physical disability 
Post trauma epilepsy 
Punch drunk syndrome 
Psychiatric illness i.e. dementia, PTSD
Chronic sub dural haemorrhage 
Intracranial infection

Question 20

How does diffuse axonal injury occur?

Answer 20

High impact force causing the brain the accelerate forwards and backwards which cause tearing of the axons

Question 21

What is the main thing you are worried about when someone has sustained diffuse axonal injury?

Answer 21

The cerebral oedema - need to decrease ICP

Question 22

What is the prognosis for diffuse axonal injury?

Answer 22

Bad because there is no treatment
You can treat the raised ICP but not the axonal injury
Majority of patients die or sustain persistent vegetative state