Traumatic Head and Spinal Injury and Raised Intracranial Pressure

Question 1

What are some secondary effects of traumatic brain injury?

Answer 1

Ischaemia, Hypoxia, Cerebral swelling (raised ICP), Infection, Epilepsy

Question 2

What is a comminuted skull fracture?

Answer 2

where there is splintering of the bone

Question 3

What causes an extra dural haematoma?

Answer 3

rupture of the middle meningeal artery

Question 4

What causes a subdural haematoma?

Answer 4

rupture of the subdural veins

Question 5

Who is more at risk of extra dural haematomas and who is more at risk of subdural haematomas?

Answer 5

young people are more at risk of extra dural and older people are more at risk of subdural

Question 6

What is a contusion?

Answer 6

haemorrhagic necrosis (bruise)

Question 7

At what sites do contusions usually occur?

Answer 7

at the site of impact, on the opposite side to the site of impact and at the base of the brain (inferior frontal and temporal lobes)

Question 8

Which cranial nerve is often damaged due to contusions?

Answer 8

the olfactory nerve

Question 9

What does an old cerebral contusion look like macroscopically?

Answer 9

at the tips of the gyri the brain tissue collapses and is yellow with haemosiderin stains

Question 10

What is a traumatic cerebral haematoma?

Answer 10

an intracerebral haemorrhage

Question 11

What does a diffuse axonal injury look like macroscopically?

Answer 11

spotty haemorrhages on the corpus callosum, thin white matter generally, brain atrophy, enlarged ventricles

Question 12

What is hydrocephalus?

Answer 12

enlarged ventricles - can occur if old blood blocks the exit foramina for CSF

Question 13

What is chronic traumatic encephalopathy?

Answer 13

frequent injuries leading to brain atrophy, abnormal deposition of Tau protein and deposition of plaques

Question 14

What is the initial response to an increase in ICP?

Answer 14

expulsion of as much CSF and venous blood as possible

Question 15

What are some potential causes of raised ICP?

Answer 15

trauma, tumour, infarction, haemorrhage, infection, cerebral oedema, overproduction of CSF, obstruction to flow or absorption of CSF

Question 16

What are the two main types of cerebral oedema and what is the difference?

Answer 16

vasogenic and cytotoxic
vasogenic is due to disruption of the blood brain barrier and can be treated with steroids
cytotoxic is due to increased intracellular fluid and cannot be treated with steroids

Question 17

What are the common sites of herniation with raised ICP?

Answer 17

cingulate gyrus pushed underneath the falx cerebri, medial temporal lobe is pushed through the tentorium cerebelli, cerebellar tonsils are pushed into the spinal canal

Question 18

What is a subfalcine herniation?

Answer 18

when the cingulate gyrus is pushed underneath the falx cerebri

Question 19

What is an uncinate herniation?

Answer 19

when the medial temporal lobe is pushed through the tentorium cerebelli

Question 20

What is a tonsilar herniation?

Answer 20

when the cerebellar tonsils are pushed into the spinal canal

Question 21

What is the result of a subfalcine herniation?

Answer 21

may result in an infarct of the corpus callosum

Question 22

What is the result of an uncinate herniation?

Answer 22

CNIII compression which causes ipsilateral pupil dilation, compression of reticular activating system causing loss of consciousness, PCA compression which affects visual cortex, compression of cerebral peduncles which causes hemiparesis

Question 23

What is the result of a tonsilar herniation?

Answer 23

compression of the respiratory centres in the medulla - fatal