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Neurology > Trauma > Flashcards

Trauma Flashcards

1
Q

types of trauma

A

missile or non missile

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2
Q

examples of missile trauma

A

penetrating - i.e. gun shot wounds,

lacerations - i.e. knife

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3
Q

mechanism of missile trauma

A

velocity dependant - fast projectiles greater damage

Cavitation occurs - bubbles appear, causes widespread surrounding damage

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4
Q

examples of non missile trauma

A

blunt trauma - impact of moving head against static surface (e.g. ground, falls, alcohol) or static head struck by moving object (e.g. hammer)
Acceleration - deceleration - RTA

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5
Q

mechanism of non missile trauma

A

brain moves within cranial cavity and makes contact with the inner table of the cranium and bony protrusions

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6
Q

what is a primary brain injury

A

injuries occuring at the time of trauma

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7
Q

what is a secondary brain injury

A

injuries that evolve after the inital trauma

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8
Q

primary brain injury mechanisms

A

extra axial haemorrhage - injury to scalp, skull and blood vessels inside or outside dura (extra/subdural)
intra-axial haemorrhage - injury to the brain
diffuse axonal injury - brain deformation and shearing caused by rotational acceleration/deceleration

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9
Q

secondary brain injury mechanism

A

intracranial haematoma, increased ICP, hypoxi/ischaemia, oedema, infection, electrolyte abnormalities

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10
Q

secondary brain injury cellular events

A

INJURY TO MICROVASCULATURE AND THE BLOOD BRAIN BARRIER OCCURS, OEDEMA, HYPOXIA
GLUTAMATE RELEASE -> EXCITOTOXICITY, INCREASED INTRACELLULAR CA2+, HYPOXIA ALSO INCREASES OXIDATIVE STRESS, CAUSING MITOCHONDRIAL INJURY AND FREE RADICAL FORMATION, THESE PROCESSES BRING ABOUT APOPTOSIS AND NECROSIS
TO AN EXTENT, FURTHER TISSUE DISRUPTION CAN EXACERBATE THE SITUATION CREATING POSITIVE FEEDBACK LOOPS OF ENHANCING LOCAL INJURY

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11
Q

Scalp Lesions

A

Bruising - contusions
Lacerations
Cause bleeding, route for infections
More likely on lateral hemisphere surface due to temporal and frontal loves having sharp bony prominences

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12
Q

What are coup injuries

A

occurs at point (side) of impact

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13
Q

what are contrecoup injuries

A

occurs diametrically opposite the point of impact

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14
Q

mechanisms of coup/contrecoup injuries

A

denser CSF moves to impact side first, forcing brain to contra-coup side 1st (contrecoup affected by more energy)
Cavitation - low pressure in brain moving away from zone opposite the impact side. Low pressure creates cavitation bubbles, which damage parenchyma

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15
Q

what would prompt you for an urgent CT head scan i.e within an hour

A

vomiting more than once

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16
Q

what would indicate a CT within 8 hours

A

> 65 years, dangerous mechanism injury and amnesia of events > 30 mins = up to 8 hours

17
Q

what are the 8 bones of the skull

A

1 frontal, 2 parietal, 2 temporal, 1 occipital, 1 sphenoid, 1 ethmoid

18
Q

what is a linear fracture

A

straight, sharp fracture line that may cross sutures (diasttaic fracture), transverse the full thickness of skull

19
Q

what is depressed fracture

A

comminute fractures in which broken bones displace inwards and damage brain

20
Q

what is a diastatic fracture

A

fracture line transverse one or more sutures of the skull causing a widening of the suture

21
Q

what is a basilar fracture

A

linear fractures that occur in the floor of the cranial vault (skull base), which require more force to cause than other areas of the cranium

22
Q

what is a growing fracture

A

also known as craniocerebral erosion or leptomeningeal cyst due to the usual development of a cystic mass filled with cerebrospinal fluid

23
Q

what is a cranial burst

A

closed, diastatic skull fracture with cerebral extrusion beyond the outer table of the skull under the intact scalp

24
Q

what is a compound fracture

A

a fracture in conjunction with an overlying laceration that tears the epidermis and the meninges - or runs through the paranasal sinuses and the middle ear structures - putting the outside environment in contact with the cranial cavity

25
Q

what are some symptoms of skull fracture

A

pain, sympotms of brain damage, fluid leaking from nose, ears, bruises around ears and eyes

26
Q

chronic subdural haematomas are commonly associated with who?

A

alcoholics

27
Q

what are the 2 kinds of traumatic haematomas

A

extradural (epidural) and intradural

28
Q

what is the mechanism of extradural haematomas

A

rupture of vessels in dura often by a tempero-parietal fracture

29
Q

what is the mechanism of subdural haematomas

A

collection of blood between the internal surface of the dura mater an arachnoid mater
caused by disruption of bridging veins that extend from the surface of the brain into the subdural space

30
Q

progression of extradural haematomas

A

immediate brain damage minimal but untreated midline shift - compression and herniation

31
Q

subdural haematomas are either…

A

acute or chronic

32
Q

types of intradural haematomas

A

subdural, intracerebral, subarachnoid

33
Q

pathology of acute subdural haematomas

A

unilateral or bilateral, asscoiated with other traumatic lesions gyral contours preserved, swelling of cerebrum on side of haematoma, mass effect, non treated haematomas become liquefied and from a yellowish neomembrane

34
Q

pathology of chronic haematomas

A

less associated with a well defined trauma, brain atrophy, composed of liquefied blood/yellow tinged fluid separated from inner surface of dura mater and underlying brain by neomembrane

35
Q

symptoms of an epidural haematoma

A

lucid interval followed by unconsciousness

36
Q

symptoms of a subdural haematoma

A

Acute - coma

Chronic - gradually increasing headache and confusion

37
Q

on a CT a subdural haematoma will appear

A

a crescent shape

38
Q

on a CT an epidural haematoma will appear

A

a biconvex shape

39
Q

treatment of a haematoma

A

evacuation, craniotomy

Neurology (18 decks)

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