Trauma and Brain

Question 1

Site of injury if patient has “raccoon sign?”

Answer 1

Basilar skull fracture of the orbital roof

Question 2

Site of injury if patient has “battle sign?”

Answer 2

Basilar skull fracture of the temporal bone

Question 3

Contusion vs. laceration

Where do they usually occur? Complications?

Answer 3

Contusion = bruise
Laceration = tear

Usually they occur at surface crests of gyri –> RISK FOR SAH

Question 4

Coup contusion vs. contercoup injury

Answer 4

Coup occurs at or deep to point of impact

Countercoup occurs at distance from point of impact.

Question 5

Common sites of contusions?

Answer 5

Orbital-frontal and temporal tips of the brain

Question 6

What vessels are normally affected in subdural hematomas?

Answer 6

Bridging veins from cortex to venous sinuses.

Usually in elderly–more brain atrophy so more empty space for brain to “rock” around

Question 7

What do you usually find pathologically with traumatic axonal injury?

Answer 7

Inertia causes sheer stress on axons to cause focal alteration.

Axons swell –> axonal spheroids.

IHC stains amyloid precursor protein (APP) can help identify because H&E.

Capillaries can be broken –> petechiae.

Question 8

How does the entrance and exit wound for bullet?

Answer 8

Exit larger than entrance wound and usually more irregular.

Exit can also leave bone fragments leading to more damage in tissue.

Question 9

Injury from high velocity bullets

Answer 9

Usually velocity more important than mass for injury.

Bullet enters and “shockwave” from radial forces creates temporary cavitation that radiates out to result in surrounding tissue damage.

Question 10

Injuries associated with “shaken baby syndrome?”

Answer 10

Retinal hemorrhages
Subdural hematoma
Traumatic axonal injury