Traumatic Head Injuries Flashcards
MLI of coup-contrecoup injuries
- Physician responsibilty: surgeon must not depend on the history or evidence of external site but on lateralizing signs and radiological findings.
- The assailant may claim that he is not responsible for conrecoup site injuries.
- Based on localization of injuries, it is possible to conclude whether it is due to blows or fall.
Mention complications of scalp injuries
- Hemorrahge as it has rigch blood supply and widely opened vessels due to traction of dense fibrous tissue.
- Sepsis: woounds superficial to OFM are not so dangerous but deep wounds extending through the galea can cause spread of infection through emissary veins to venous sinuses leading to meningitis and brain abscess.
DD of black eye
- Local violence
- Bleeding into the layer of loose connective tissue
- Fracture of orbital plate of frontal bone (anterior cranial fossa fracture)
Describe the causative instrument in each type of skull fracture
- Fissure f.: heavy blunt broad object applied with low momentum
- Depressed (signature) f.: heavy blunt object with localized surface applied with high momentum
- Comminuted (spider’s web) fracture: heavy blunt object with wide striking surface applied with high momentum
- Cut depressed fracture: heavy sharp or semi-sharp instrument with high momentum
Enumerate complications of vault fractures
- Injury to brain
- Intracranial hemorrahge
- Infections
- Cerebral edema
- Sequels of permenenat infirmity caused by bone gap (weak point in protection of head contents, Jacksonian epilepsy, intracranial infections)
- Incread ICT due to bone fragments or ICH
- Death
List possible fates of concussion and its MLI
A. Fates:
1. Complete recovery
2. Incomplete recovery (post-concussion syndrome): a. Retrograde amnesia, post-traumatic automatism or neurosis.
3. Complicated concussion: death, passes to compression directly or with lucid interval
B. MLI:
1. Retrograde amnesia: patient is unable to recollect events leading to accident or injury, may be true or false in malingering.
2. May be confused with drunkenness
3. Patients iwth post-traumatic automatism or neurosis are not legally resposible for their actions
List the dangerous symptoms of concussion
- Headache is worsened or does not go away
- Slurred speech, weakness, numbness, or decreased coordination
- Significant nausea or repeated vomiting
- Seizures
- LOC
- Inability to wake up
- Symptoms have worsened by time
MLI of lucid interval
- Medical responsibilty of negligence:
Any victim of head trauma must be kept for observation for 24-48 hours and vitals are monitored every 15 min. Decompression operation must be done to remove bone or heatoma if patient develops DLOC or tachycardia. Otherwise, if patient dies it is the responsibility of the physician. - The assailant may deny responsibility as the victim regained normal life
- The victim may talk about the assailant and the whole circumstances
MLI of intracraial hemorrahge
- Good prognosis with urgent and proper treatment so hematoma on the contralateral side should be excluded
- Early symptoms of EDH or SDH may resemble drunkenness and pt may die in police custody
- Pt may be discharged from hospital during lucid interval and die at home doctor may be charged with negligence
- It is possible to testify that trauma induced or precipitated the rupture of developmental Berry aneurysm when symptoms of unexplained acute neurological deficit arise after head trauma
- Symotoms of SDH may be mistaken for schizophrenia, pre-senile or senile dementia
Main causes of increased ICT in forensic medicine
- Depressed cranial fractures
- Intracranial hemorrhage
Mention complications of head injuries
- Retrograde amnesia
- Post-traumatic automatism/neurosis
- Jacksonian epilepsy
- Sepsis (mengitis, CST)
- Permenant infirmity due to cranial nerve paralysis
- Cushing ulcer as inc ICT incadrenal steroids
- Death (DAI, brain laceration, ICH or compression)
