Traumatic Head Injury

Question 1

Definitiation of head injury

Answer 1

1 of following

Loss of consciousness
Amneisa after traumatic event
Confirmed brain injury
Skull fractie

Question 2

Gender and age with head injury

Answer 2

Risk is 2X greater in males and risk of fatal 4X in males

Most in 15-24 y/o

Question 3

Causes of head injury

Answer 3

Most a vehicular accidents

Question 4

Lesions in various spots

Answer 4

Frontal - asympto
Spianl cord - paralysis
Brainstem - death

Question 5

Penetrating
Blunt
Open

Answer 5

Penetrating - agent directly pierces into scalp, skull, meninges and brain tissue

Blunt - object deforms the head but no penetration…accidents and falls

Open - skull fracturd

Question 6

Closed
Coup
Contrecoup

Answer 6

Closed - scalp may be cut but everything else in tact
Coup - injurys lie directly beneath POI
Contrecoup - injury to those that lie opposite to point…when brain moves and strikes other side of skull

Question 7

Types of head injury

Answer 7

Skull fracture
Parenchymal brain injury
Vaqscular injury

Question 8

Skull fractures location, types

Answer 8

Most are in thin parts
Most are linear (radiate opposite direction from POI)
Most do not cross suture lines of skull…tend to isolatei n one bone

Diastatic fracture crosses suture lines and involves more than 1 bone

Question 9

Depress skull fracture

Answer 9

When a portion of skull bone displaced into cranial cavity by distance greater than thickness of the bone

Question 10

COmplications of skull fractures

Answer 10

If no damage to brain or meninges, then heals

Damage to parenchyma (risk with depressed frcture)

Trauam to intracranial blood vessels with hemorhhage (esp epidural hematoma)

Bacterial meningitis in open

Question 11

Concussion

Answer 11

Immediate disruption of CNS

Temportary and reversible

Blunt injury causes change in momentum of head

Question 12

Concussion syns and smyptoms

Answer 12

Loss of consciousness, temporary resp arrest, loss of reflexes, loss of muscle tone

Recovery in 24 hours

Amnesia almost always accompanies

Question 13

CTE

Answer 13

Chronic traumatic encephalopathy

Degen dz from repeated brain trauam

Histologic changes mimic alzheimers (tau protein)

Question 14

Contusion

Answer 14

Bruise of brain surface by blunt trauma

Dura may be torn but leptomeninges intact

Coup or contrecoup

Occur at gyri of cerebral cortex

Wedge shaped area of hemorrhae with bae of wedge at brain surface

Question 15

Clinical contusion

Answer 15

Headache
Dizziness
mental status changes
Seizures

Question 16

Lacerations

Answer 16

Disruptions of leptomeninges and brain parenchyma

Pentrating head wounds like depressed skull fractures

Heals by gliosis and can serve as focus for seizure activyt

Question 17

Epidural hematoma

Answer 17

Spacce occupying intracranial lesions
5-15% of all fatal
Typically coup
Accompanied by skull fractures

Question 18

Mech of epidural hematoma

Answer 18

Most are trauam to dural arteries

Middle meningeal is most common

Question 19

Epi dural comps and clinical course and tx

Answer 19

Compression of prain
Increased can lead to tonsillar hernation which can lead to compression and necrosis of brainstem

Acute and rapidly progressive due to high pressure bleeding…emergency

Typical clinical picture is loss of consciousness after injury followed by lucid interval followed by loss of consciousness again

Neurosrugery where hole drilled in skull

Question 20

Subdural hematoma and groups affected

Answer 20

Space occupying
Bridging veins

Battered infants
Alcoholics
Boxers
Elderly - brain atrophy leads to strethcing of veins

Question 21

Clinical course and tx of subdural hematoma

Answer 21

Slowly bleeding because of veins

Confusion, loss of consciousness, disoreintation, hemiplegia, coma, death

Occur weeks or months after injury

tx is same

Question 22

SAH

Answer 22

Always results in bloody CSF
Most common are veins in subarachnoid space

Blood is in contact iwht meninges and can cause chemical meningitis

Blood can cause vasopasm of other blood veseels leading to ischemic injury and infarcts of other brian areas