Trauma Flashcards
What is the feared complication with skullbase/paranasal fractures?
Meningitis
Also get CSF leaks and pneumocephalus
Gas in the TMJ should prompt search for what?
Temporal bone fracture
What is a depressed fracture?
How are they treated?
Fragment displacement >0.5cm
Considered open, requiring debridement and abx
What is a growing fracture?
Herniation of brain through the fracture
What is the risk with a fracture crossing the midline vertex?
Superior sagittal sinus injury
What artery in injured in most cases of epidural hematoma? What percentage of severe head trauma patients will have an epidural hematoma?
Middle Meningeal artery
50-75%
In children, what vessels are involved with epidural hematomas?
Venous sinuses
When should a venous sinus origin be suspected in epidural hematoma?
When hematoma abuts both sides of the tentorium or is adjacent to a dural venous sinus
Which hematoma is associated with a lucid interval?
Epidural, 50%
What percentage of severe head trauma patients have subdural hematoma? What vessel is usually involved?
How many are bilateral?
10-20%
Bridging veins
10-15%
What location of subdural hematoma suggests abuse in children?
Interhemispheric
What is a dural hygroma?
collection of nonbloddy CSF in the subdural space caused by a tear in the arachnoid membrane
Who gets hematohygroma?
Child abuse
What is the mechanism of DAI?
sudden deceleration and rotation of brain
Where are DAI most commonly seen?
Frontotemporal at grey white junction
Basal ganglia, splenium of corpus callosum, dorsal midbrain
What sequence is most sensitive for DAI on MRI?
GRE (T2*) and SWI
DWI will show signal secondary to shearing of small arteries and subsequent infarction
Acute hematoma in the dependent ventricle in the setting of trauma suggests what?
Shearing of subependymal veins
What are intermediary injuries? What is the vessel?
Shearing injury of the lenticulostriate arteries seen with DAI. Result in bilateral BASAL GANGLIA hemorrhagic contusions
Where are brain contusions usually found? Why?
What brain location are they found?
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
What is the progression of cerebral contusions?
How many are multiple? What percentage have an intraventricular component?
Many are non hemorrhagic initially, but will become hemorrhagic 72 hours later, and thus will appear larger on subsequent scans
30%, 1-5%
What is the main difference between traumatic and nontraumatic SAH?
traumatic have less blood than aneurysm rupture -> less risk of vasospasm
What is the pseudodelta sign?
Hyperdense blood layers along posterior superior sagittal sinus
Can also be seen in interpeduncular cistern
How does SAH appear of MRI?
Where is FLAIR limited in eval for SAH
high signal on T2 FLAIR, artifact on GRE
FLAIR is hampered by CSF flow in basilar cisterns, so FLAIR is best for supratentorial SAH
What causes high CSF signal on FLAIR?
Meningitis, cancer, blood, oxygen, anesthesia, melanosis, gadolinium
What is the most common brain presentation in child abuse?
Subdural hematoma of different ages
Also see complex/bilateral skull fractures, contusions
Hemispheric infarct in kids suggests what?
dissection of cervical or supraclinoid ICA
What are secondary signs of child abuse in the head and neck?
Cervical spinal cord injury
Ocular injury
Shearing of pituitary stalk
What is the association with air travel related pneumocephalus?
Frontal sinus osteoma and congenital abnormalities of inner ear
When does pneumocephalus need treatment?
Tension = mass effect and high pressure results in symptoms
What is the mount fuji sign?
Bilateral large air accumulations in the frontal convexities giving an irregular appearance to the frontal lobes
What are causes of nontraumatic arterial dissection?
FMD HTN Migraine, OCP Collagen vascular diorders Pharyngeal infections
What are the presenting signs of arterial dissection (ICA)
Sudden neck pain
Horner syndrome
Stroke (watershed infract)
Where are common sites of ICA dissection?
Bifurcation
Skull base
Supraclinoid
Areas of acute angularity
Where are common sites of vertebral dissection?
c6 (entrance of foramen transversarium)
C1 and foramen magnum (as it pierces the dura)
What suggests dissection versus clot in the ICA?
Semilunar appearance favors dissection due to displacement of media
With a ventriculostomy catheter and decompression of the lateral ventricles, what should be evaluated specifically?
Subdural hematoma
