Trauma - Fremont-Smith Flashcards
skull fractures
linear
depressed
may create communication
trauma to brain
impact injury
and movement of brain injury
middle meningeal artery
in epidural space
branch of external carotid artery - does not go into brain parenchyma
bridging veins
cross meningeal layer to skull
bleed into subdura between arachnoid and meningeal layer of dura
cerebral arteries
to SA space
lens shaped lesion on CT
epidural hematoma
because confined to dural sutures
break bridging vessels
subdural hematoma
crescent shaped lesion on CDT
subdural hematoma
shaken baby syndrome
get subdural hematoma
subdural space
not connected to arachnoid space - where CSF is
blood over time on CT
bright white (hyperdense) and fades to gray (isodense)
hematocrit effect
The hematocrit effect is a blood-plasma level seen with acute re-bleeding into an older subdural blood collection.
hygroma
chronic subdural hematoma
-is liquefied inside
subarachnoid hemorrhage
bleeding in sulci - in virchow robin space
ruptured berry aneurysm
SA hemorrhage
one punch to head death
traumatic SA hemorrhage
-vertebral artery rupture - at C1
hypoxic ischemic encephalopathy
blood in SA space - toxic on vessels - get vasospasm
- decreased O2 to brain
- global ischemia
- cells die
- fluid to edema - bad cycle
shaken baby syndrome triad
encephalopathy
subdural hematoma
retinal hemorrhage - vitreous moves rips retina
hemorrhagic necrosis of brain tissue
contusion
location of contusions
more frequent - orbital surfaces of frontal lobes and tips of temporal lobes
traumatic axonal injury
DAI - diffuse axonal injury
stretching of axons
wallerian degeneration
with moderate/severe axon degeneration
CNS myelin
oligodendrocytes
PNS myelin
schwann cells
wallerian degeneration
process that results when a nerve fiber is cut or crushed, in which the part of the axon separated from the neuron’s cell body degenerates distal to the injury
marker for DAI
beta-amyloid precursor protein
tau protein
in microtubule of axons
anoxic neuron
red neuron
-injured neuron shrinks, becomes eisinophilic, mito condense, become pyknotic
concussion
mild to severe DAI
loss of consciousness - dysfunction of reticular activating substance - upper brainstem
chronic cumulative effect - chronic traumatic encephalopathy
chronic traumatic encephalopathy
CTE
-repeated DAIs
atrophy in cerebral cortex, white matter, deep nuclei, brainstem
show tau deposits
tau deposits
in CTE
phosphorylation of tau
forms aggregates
-alzheimers disease
high tau in CSF
slow recovery after head trauma
subfalcine herniation
usually asymptomatic
-may compress anterior cerebral artery - infarction
central herniation
CN VI compromised - lateral rectur palsy
B/L - hemiparesis or full paresis and coma
uncal transtentorial herniation
CN 3 palsy - blown pupil
compress posterior cerebral a
compress corticospinal tract
blown pupil
with uncal transtentorial herniation
ipsilateral
tonsillar herniation
brainstem compromise - respiratory and cardiac effect
death
small intracranial mass
can compensate for increasing ICP
-reduce CSF and blood volume
irritable and depressed alertness and attention
symptom of elevated ICP
duret hemorrhage
with herniation - get compression of vessels
usually in pons
hemiplegia with uncal herniation
is contralateral
kernohans phenomenon
ipsilateral hemiplegia caused by contralateral corticospinal tract compression
lumbar puncture on patient with inceased ICP
bad - herniation
corticospinal tract
decussate below brain - cervical level
so motor control is C/L
