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*Nervous System - Pathology > Pathology of Head Injury > Flashcards

Pathology of Head Injury Flashcards

1
Q

What is primary insult in head injury?

A

Focal and/or diffuse brain trauma

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2
Q

What are secondary insults (can result from primary insult) in head injury?

A

Hypotension
Hypoxia
Infection
Haematoma

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3
Q

How is conscious level assessed?

A

Glasgow Coma Scale (scored out of 15)

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4
Q

How does the GCS correlate with severity of head injury?

A 
13-15 = mild injury 
9-12 = moderate injury 
3-8 = severe injury
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5
Q

Give 7 significant complications of head injury?

A
  • Permanent physical disability
  • Post traumatic epilepsy
  • Intracranial infection
  • Psychiatric illness
  • Chronic subdural haemhorrage
  • ‘Punch-drunk’ dementia
  • Fatal outcome (uncommon)
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6
Q

What is a common site for laceration?

A

The scalp (because it is closely applied to the skull and tearing associated with application of force more likely to occur - anvil effect)

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7
Q

What do scalp lacerations commonly mimic?

A

An incised wound (important to differentiate as different mechanism of injury - knife)

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8
Q

Where may bruising/bleeding occur when not on outer surface of scalp?

A

May occur in the deeper layers of the scalp or between scalp and skull (particular note in infant head injury)

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9
Q

What are the 2 elements to the skull?

A
  • Skull vault - frontal, temportal, occipital bone + sutures

- Skull base - anterior, middle, posterior cranial fossae

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10
Q

What are the 5 types of skull fracture?

A 
Linear
Depressed
Comminuted (mosaic)
Ring 
Contre-coup
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11
Q

Which is the simplest skull fracture?

A

Linear - ‘hinge’ fracture, fractures can spread along and reach suture and split suture (‘sprung’)

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12
Q

What does a depressed fracture commonly arise from?

A

Impact on protruding object or blunt force e.g. fro hammer

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13
Q

What are the risks from a depressed fracture?

A

Meningitis and post-traumatic epilepsy (fragments pushed inwards to damage meninges, blood vessels + brain)

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14
Q

What is a comminuted fracture?

A

Fragmented skull

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15
Q

What is a ring fracture?

A

Fracture line encircling foramen magnum caused by fall from height (usually land on feet but can be head)

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16
Q

What does a contre-coup fracture result from?

A

A fall onto back of head

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17
Q

What does a contre-coup fracture present as?

A

Fracturing of orbital plates; black ‘panda eyes’ classic of basal skull fractures

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18
Q

How are intracranial hamehorrhages named?

A

By their position within the skull in relation to the meninges i.e. extradural, subdural, subarachnoid

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19
Q

What does the accumulation of blood within the rigid skull in haemhorrage cause?

A

Raised ICP - results in brain compression causing symptoms like reduction in conscious level

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20
Q

What will ultimately occur as ICP increases without intervention (e.g. drill holes in skull)?

A

Death by compression of brainstem due to herniation of cerebellar tonsils into the foramen magnum

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21
Q

What is an extradural haemhorrage?

A

Bleeding occuring between the dura and skull

22
Q

What do vast majority EDH arise from?

A

Damage to artery in association with skull fracture (80-90%); sometimes large venous channels can cause

23
Q

Which artery is classically responsible for EDH?

A

Middle meningeal artery

24
Q

Again, what does the accumulation of blood in EDH cause?

A

Raised ICP and associated symptoms

25
Q

What type of interval can occur during an EDH?

A

Lucid interval - victim can then deteriorate catastrophically later

26
Q

What is a subdural haemhorrage?

A

Bleeding occuring beneath the dura and above the arachnoid

27
Q

What is SDH usually caused by?

A

Bleeding from bridging veins which pass from the surface of the brain to drain into large venous channels within the dura

28
Q

Which type of motion can cause veins to stretch and be torn due to relative movement between brain and dura?

A

Any motion which causes rotational or ‘shearing’ forces; associated with trauma like an accelerated fall; frequently occurs without skull fracture

29
Q

Which individuals are at increased risk of SDH?

A

Individuals with atrophic (small) brains because smaller brain has greater capacity for movement and veins may already be stretched

30
Q

What type of intervals can occur in SDH?

A

Lucid interval (classically long - GCS 14/15 then gradually become comatose)

31
Q

Can you get chronic SDH?

A

Yes, particularly in elderly (may cause chronic confusion - mistaken for dementia)

32
Q

What is a subarachnoid haemhorrage?

A

Bleeding beneath arachnoid membrane (and above brain); most common haemhorrage

33
Q

What is the most common cause of SAH?

A

Rupture of cerebral artery ‘berry’ aneurysm (within circle of willis); blood can track very far because tissue is looser

34
Q

What does SAH present as?

A

Thunderclap headache (sudden onset)

35
Q

What is SAH frequently seen in association with?

A

Cerebral contusions (bruising to brain)

36
Q

What is traumatic brasal SAH?

A

A specific entity in forensic medicine - person falls down dead in immediate cardiac arrest - very sudden blow to neck or side of head (damage to brainstem); thought to be due to rapid movement causing immediate rupture of vertebral arteries

37
Q

What is cerebral oedema?

A

Generalised brain swelling in response to focal/diffuse injury; can develop in minutes

38
Q

What can cerebral oedema cause?

A

Secondary brain ischaemia - further swelling; often THE cause of death in head injury due to raised ICP

39
Q

What is cerebral contusion/laceration?

A

Direct mechanical damage to brain surface

40
Q

What can cause laceration to the brain?

A

Very high forces are required e.g. RTA or fall from height

41
Q

What are contusions?

A

Patchy areas of haemhorrage within grey matter (cortical layer) - if extensive enough will go to white

42
Q

What are 2 types of contusion?

A

Coup (contusion directly under site of impact) + contre-coup (other side of head)

43
Q

What can happen with contusion injuries over a few days?

A

Patient is fine initially, then suddenly become comatose a few days later prob due to extension of contusional injuries

44
Q

What is diffuse axonal injury?

A

Tearing of nerve fibres in white matter of brain

45
Q

What is diffuse axonal injury called in terms of trauma?

A

tDAI

46
Q

How is tDAI diagnosed?

A

Microscopy of brain tissue - swelling of axons (can try and date survival times etc) (but may get concomitant damage to small blood vessels within brain which raise suspicions of tDAI)

47
Q

What are tDAI usually caused by?

A

Scenarios associated with tDAI - vehicular collisions and falls from height - serious rotational forces

48
Q

What parts of the brain are particularly susceptible to tDAI?

A

Corpus callosum, para-sagittal white matter, posterior internal capsule, dorsolateral aspects of rostral brainstem, cerebellar peduncles

49
Q

What state are patients usually in when tDAI is fully developed?

A

Coma

50
Q

How is tDAI graded?

A

1 to 3; grade 2/3 would expect patient to be unconscious immediately

*Nervous System - Pathology (13 decks)

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