Pathophysiology of Traumatic Head Injury & Herniation Syndromes Flashcards
An 8-month-old baby is autopsied. The corner notes optic nerve sheath hemorrhage. The police want to know if foul play was involved. How should the corner respond?
Possibly - optic nerve sheath hemorrhage is very indicative of rapid acceleration/deceleration. This may be a result of shaken baby syndrome
This type of skull fracture is most associated with jumping from a building.
Ring fracture - fracture around foramen magnum. These are generally fatal
What is a cingulate gyrus herniation?
Expansion of the cerebral hemisphere that displaces the cingulate gyrus
In a head injury, an injury to the brain that occurs under the site of impact is termed…?
Coup injury
What is a coup injury?
A cerebral contusion under the site of a head injury
This hematoma is most often arterial in nature, commonly involving the middle meningeal artery.
Epidural hematoma - more rapid blood accumulation due to arterial origin
This type of injury generally appears in a linear pattern due to being hit with a blunt object.
Contusion
This type of facial fracture causes separation of a part of the mandible and often contains teeth.
Dentoalveolar fracture
A patient experiences head trauma. The radiology report describes a pear-shaped hemorrhage. What kind of hemorrhage is this?
Epidural hemorrhage
A sagittal fracture through the maxilla is what type of fracture?
Sagittal fracture
How does a coup injury differ from a counter-coup injury?
A coup injury occurs on the brain under the site of impact. A counter-coup injury occurs on the side of the brain opposite the site of impact
A hemorrhage just below the scalp is termed? This type of hemorrhage may be difficult to diagnose clinically.
Subgaleal hematoma
This hematoma is most often venous in nature and has a higher survival rate due to slower blood accumulation.
Subdural hematoma
Simply put, how do LeFORT I-III fractures differ?
Fractures ascend more cranially from LeFORT fracture I to III
This type of injury is due to wearing or rubbing away by friction.
Laceration
True/False. Structural damage will be noted on imaging following a concussion.
False. There is functional damage, but no structural damage that will appear on imaging.
An 80yo woman experiences a syncope episode at home, falls forward, and experiences various trauma to the face. The patient is later found deceased by a loved one. What is the probable cause of death?
Terminal fall injury - often due to loss of consciousness and injury to the bony prominences of the face
A high transverse fracture involving the maxilla that passes through the medial orbital wall is what type of head fracture?
LeFORT III
A fracture of the maxilla above the apices of the teeth through the nasal septum and maxillary sinuses is what type of head fracture?
LeFORT I
A patient experiences head trauma. The radiology report describes a crescent-shaped hemorrhage. What kind of hemorrhage is this?
Subdural hemorrhage
Diffuse axonal injuries present in the white matter of the brain. Where are DAIs most commonly found?
Midline and paramedian structures (corpus callosum, internal capsule, cerebral peduncles) that absorb the most force following impacts
What is a LeFORT II fracture?
Pyramidal fracture that curves near the zygomatic-maxillary suture and through the orbital floor
What is a diastatic fracture?
Fracture with sawtooth appearance, often found in younger persons with sutures that have not fully formed
What morphologic changes present with chronic cerebral edema?
Flattening of gyri and narrowing of sulci
What are the types of facial fractures?
Dentoalveolar, LeFORT I, LeFORT II, LeFORT III, Sagital
Pupillary dilation may be indicative of what type of brain herniation?
Transtentorial herniation - the temporal lobe is compressed under the tentorium, compressing CN III
These types of hematomas are most often associated with tramua.
Subdural and epidural hematomas
What are common causes of a subarachnoid hematoma?
Rupture aneurysm, trauma (vertebral artery trauma), drugs
Axonal swelling and beta-amyloid precursor proteins are hallmark findings of what type of brain injury?
Diffuse Axonal Injuries
What type of brain herniation is the most severe?
Tonsilar herniation due to brainstem compression
How does a laceration differ from a cut?
A laceration occurs when a blunt object tears the skin. The edges are not smooth and size and shape of the wound varies depending on the object
This type of skull fracture leads to fragments that injure the brain.
Depressed fracture