Trauma Pathology (the gross lecture)

Question 1

Name two types of hemorrhages that are commonly seen in newborns

Answer 1

1. Caput succedaneum (just under skin)

2. Caphalhematoma (between periosteum and skull)

Question 2

Linear fracture

Answer 2

Secondary to contact with large flat object. Least serious

Question 3

Compound fracture

Answer 3

Occurs with scalp laceration (ie cranial cavity is in contact with outside world)

Question 4

Complex fracture

Answer 4

Fracture involving multiple bones

Question 5

Depressed fracture

Answer 5

Broken bones are displaced inward. Secondary to contact with small objects (like a hammer head).

Question 6

Contrecoup fracture

Answer 6

Located distant from point of entry (like you hit the back of your head and the front has a fracture due to impact)

Question 7

Hinge fracture

Answer 7

Most serious basal skull fracture in which the fracture extends between the anterior and posterior skull

Question 8

Epidural hemorrhage

Answer 8

Between the skull and dura, due to arterial bleeding

Question 9

Subdural hemorrhage (what is it and what is its pathogenesis)

Answer 9

Below the dura, due to venous bleeding

-can lead to compression of the brain

Pathogenesis:

• Caused by motion of brain with respect to skull and dura, tearing bridging veins (ie veins in the dura matter)
• Located over cerebral convexities
• Increased risk in ppl with brain atrophy
• Tears of veins more likely with rapid accel/decel

Question 10

Fracture contusion

Answer 10

Occurs in conjunction with a fracture

Question 11

Coup contusion

Answer 11

Bruising of the brain. Usually a moving object striking a stationary, but movable head

Question 12

Contre-coup contusions

Answer 12

Located distant, usually opposite from point of impact. Occurs when moving head strikes a stationary object (like falling and hitting the back of your head and the front having contusions)

-Most commonly occur at orbito-frontal surfaces and temporal poles

Question 13

Closed head injury

Answer 13

Result from severe angular acceleration (bike accident, shaken baby).

Usually involves corpus callosum, fornix, deep grey, subcortical white of frontal cortex. Also primary pontine trauma

Question 14

What are the 3 characteristic consequences of closed head injuries? Include detail

Answer 14

Diffuse axonal injury:
-Retraction balls (axonal swellings)

Pathophysiological Effects of concussion:

• Elevated glutamate
• Activation of Na/K pump
• Elevated intracellular Ca leading to neuronal cell death
• Elevated lactic acid

Brain swelling
-Accelerated forces can result in damage to cell membranes of neurons, contributing to edema

Question 15

Shaking injuries leads to

Answer 15

• SDH
• Gliding contusions
• Transection of corpus callosum or spinal cord
• Optic nerve sheath hemorrhages
• Black brain (widespread necrosis)