Traumatic Head/Spinal Injury Flashcards
2 kinds of skull fractures
linear
depressed
concussion is defined as?
clinical term
instantaneous loss of consciousness
temp resp arrest
loss of reflexes
pathogenesis of concussion?
maybe brainstem?
percentage of CNS injury:
all deaths
deaths from trauma
deaths from MVAs?
1% all deaths
30% deaths from trauma
50% deaths from MVAs?
what is penetrating injury?
direct disruption of tissue
what is a closed injury?
movement and compression of brain within skull
2 acute secondary effects of traumatic head injury?
ischemia
hypoxia
3 delayed secondary effects of traumatic head injury?
increased ICP
infection
epilepsy
difference between open and closed fracture of skull?
open communicates with outside world, increase risk of infection
splintering of bone?
comminuted
when do you get blood/csf from nose/ears?
basal fracture
cause of epidural hematomas? more likely in what age group?
middle meningeal artery
younger age group
cause of subdural hematomas? more likely in what age group?
subdural veins, acute or chronic
older ppl more likely, brain shrinkage
what is brain contusion?
hemorrhagic necrosis bruising
what is coup?
site of impact
what is contrecoup?
opposite site of impact
where do sterotypic contusions occur?
base of brain, inferior frontal and temporal lobes
what does an old cerebral contusion look like macroscopically?
collapsed brain tissue
orange staining
scarring at tips of gyri
what is a vulnerable site if too much energy transfer?
ponto-medullary junction
What is particularly vulnerable to TAI/DAI?
corpus callosum
what is diffuse axonal injury?
diffuse vascular injury, usually secondary
what is a histological sign of diffuse axonal injury?
axonal spheroids: build up of proteins in broken axons
longterm effects of diffuse axonal injury includes?
brain atrophy
enlarged ventricles
thin corpus callosum
less white matter
what happens to spinal cord in vertebral # and dislocation?
cord compression, toothpaste effect
4 longer term sequelae of brain trauma?
infections
hydrocephalus ( blocked 4th ventricle exits)
epilepsy
chronic traumatic encephalopathy
chronic traumatic encephalopathy features? 3
brai atrophy
abnormal Tau protein deposition
A/B plaque deposition
how much blood and CSF in brain?
150ml each
how does blood and CSF react initially to trauma?
drainage of both as much as possible, then increase ICP (explains delay)
when do you get zero brain perfusion?
as ICP approaches arterial pressure
what happens to brain tissue close to dural openings?
herniations
big causes of raised ICP? 5 things
cerebral oedema trauma hemorrhage infection too much or blocked exit of CSF
2 subtypes of cerebral oedema
vasogenic: white matter BBB more permeable
cytotoxic: white and grey matter, increased INTRAcellular fluid.
which cerebral oedema is responsive to steroids?
vasogenic
NOT cytotoxic
