Prayson Trauma

Question 1

Lateral transtentorial herniation

Answer 1

Parahippocampal or uncal herniation. Assoc. w/ supratentorial masses. Displacement of uncus and parahippocampal gyrus beneath the tentorial notch.
Kernohan’s notch: damage to the contralateral cerebral peduncle leading to motor impairment ipsilateratl to the herniation
Damage of the ipsilateral 3rd CN (oculomotor)- first sensory (dilated and fixed) and then motor (down and out)
PCA intrapment/compression causting infarction of the calcarine cortex
Midline brain stem hemorrhage and Duret hemorrhages

Question 2

Central herniation

Answer 2

2/2 parenchymal lesion in the frontal and parietal lobes. Herniation of the thalamus and midbrain.
Compression of the ant choroidal artery w/ infartction of the globus pallidus and optic tract

Question 3

Subfalcine herniation

Answer 3

aka Cingulate or supracallosal herniation. 2/2 mass lesion in frontal or parietal lobe. Displacement of the cingulate gyrus unde the falx.
ACA displacement and infarction

Question 4

Gunshot Exit wound

Answer 4

Usually tears in the skin, broader outer table bevel

Question 5

Gunshot entrance wound

Answer 5

broader inner table bevel; abrasion, soot, stippling

Question 6

Raccoon eyes

Answer 6

fracture of orbital plates of the ant cranial fossa

Question 7

Battle sign

Answer 7

Mastoid fracture of petrous bone lacerating the internal carotid artery

Question 8

Diffuse axonal injury

Answer 8

Immediate decreased level of consciousness or loss of consciousness. MVA and shaken infants.  Damage to corpus callosum, fornix, corona radiata, sup. cerebellar peduncles.  Punctate or streak like hemorrhages. 
Axonal injury (spheroids/retraction balls) seen 4-12 hours after injury, APP positive after 2 hours

Question 9

Fat emboli

Answer 9

Sudden onset of tachypnea, dyspnea, and tachycardia 1-3 days after injury. Peticheal white matter hemorrhages. Ring and ball hemorrhages

Question 10

Child abuse

Answer 10

Scalp contusion, subdural hemorrhage, perioptic nerve and retinal hemorrhage, hypoxic brain injury, and skull fractures