Trauma

Question 1

What is the feared complication with skullbase/paranasal fractures?

Answer 1

Meningitis

Also get CSF leaks and pneumocephalus

Question 2

Gas in the TMJ should prompt search for what?

Answer 2

Temporal bone fracture

Question 3

What is a depressed fracture?

How are they treated?

Answer 3

Fragment displacement >0.5cm

Considered open, requiring debridement and abx

Question 4

What is a growing fracture?

Answer 4

Herniation of brain through the fracture

Question 5

What is the risk with a fracture crossing the midline vertex?

Answer 5

Superior sagittal sinus injury

Question 6

What artery in injured in most cases of epidural hematoma? What percentage of severe head trauma patients will have an epidural hematoma?

Answer 6

Middle Meningeal artery

50-75%

Question 7

In children, what vessels are involved with epidural hematomas?

Answer 7

Venous sinuses

Question 8

When should a venous sinus origin be suspected in epidural hematoma?

Answer 8

When hematoma abuts both sides of the tentorium or is adjacent to a dural venous sinus

Question 9

Which hematoma is associated with a lucid interval?

Answer 9

Epidural, 50%

Question 10

What percentage of severe head trauma patients have subdural hematoma? What vessel is usually involved?

How many are bilateral?

Answer 10

10-20%

Bridging veins

10-15%

Question 11

What location of subdural hematoma suggests abuse in children?

Answer 11

Interhemispheric

Question 12

What is a dural hygroma?

Answer 12

collection of nonbloddy CSF in the subdural space caused by a tear in the arachnoid membrane

Question 13

Who gets hematohygroma?

Answer 13

Child abuse

Question 14

What is the mechanism of DAI?

Answer 14

sudden deceleration and rotation of brain

Question 15

Where are DAI most commonly seen?

Answer 15

Frontotemporal at grey white junction

Basal ganglia, splenium of corpus callosum, dorsal midbrain

Question 16

What sequence is most sensitive for DAI on MRI?

Answer 16

GRE (T2*) and SWI

DWI will show signal secondary to shearing of small arteries and subsequent infarction

Question 17

Acute hematoma in the dependent ventricle in the setting of trauma suggests what?

Answer 17

Shearing of subependymal veins

Question 18

What are intermediary injuries? What is the vessel?

Answer 18

Shearing injury of the lenticulostriate arteries seen with DAI. Result in bilateral BASAL GANGLIA hemorrhagic contusions

Question 19

Where are brain contusions usually found? Why?

What brain location are they found?

Answer 19

Grey matter/cortex due to rich vascularity, usually hemorrhagic on presentation or become hemorrhagic in 72 hours

Tips of frontal and temporal lobes, undersurface of frontal lobe, and dorsolateral midbrain

Question 20

What is the progression of cerebral contusions?

How many are multiple? What percentage have an intraventricular component?

Answer 20

Many are non hemorrhagic initially, but will become hemorrhagic 72 hours later, and thus will appear larger on subsequent scans

30%, 1-5%

Question 21

What is the main difference between traumatic and nontraumatic SAH?

Answer 21

traumatic have less blood than aneurysm rupture -> less risk of vasospasm

Question 22

What is the pseudodelta sign?

Answer 22

Hyperdense blood layers along posterior superior sagittal sinus

Can also be seen in interpeduncular cistern

Question 23

How does SAH appear of MRI?

Where is FLAIR limited in eval for SAH

Answer 23

high signal on T2 FLAIR, artifact on GRE

FLAIR is hampered by CSF flow in basilar cisterns, so FLAIR is best for supratentorial SAH

Question 24

What causes high CSF signal on FLAIR?

Answer 24

Meningitis, cancer, blood, oxygen, anesthesia, melanosis, gadolinium

Question 25

What is the most common brain presentation in child abuse?

Answer 25

Subdural hematoma of different ages

Also see complex/bilateral skull fractures, contusions

Question 26

Hemispheric infarct in kids suggests what?

Answer 26

dissection of cervical or supraclinoid ICA

Question 27

What are secondary signs of child abuse in the head and neck?

Answer 27

Cervical spinal cord injury
Ocular injury
Shearing of pituitary stalk

Question 28

What is the association with air travel related pneumocephalus?

Answer 28

Frontal sinus osteoma and congenital abnormalities of inner ear

Question 29

When does pneumocephalus need treatment?

Answer 29

Tension = mass effect and high pressure results in symptoms

Question 30

What is the mount fuji sign?

Answer 30

Bilateral large air accumulations in the frontal convexities giving an irregular appearance to the frontal lobes

Question 31

What are causes of nontraumatic arterial dissection?

Answer 31

FMD
HTN
Migraine, OCP
Collagen vascular diorders
Pharyngeal infections

Question 32

What are the presenting signs of arterial dissection (ICA)

Answer 32

Sudden neck pain
Horner syndrome
Stroke (watershed infract)

Question 33

Where are common sites of ICA dissection?

Answer 33

Bifurcation
Skull base
Supraclinoid

Areas of acute angularity

Question 34

Where are common sites of vertebral dissection?

Answer 34

c6 (entrance of foramen transversarium)

C1 and foramen magnum (as it pierces the dura)

Question 35

What suggests dissection versus clot in the ICA?

Answer 35

Semilunar appearance favors dissection due to displacement of media

Question 36

With a ventriculostomy catheter and decompression of the lateral ventricles, what should be evaluated specifically?

Answer 36

Subdural hematoma