W19-L11: Traumatic head and spinal cord injury

Question 1

Direct effects of trauma can be seen in

Answer 1

SCALP – lacerations

SKULL – fractures

MENINGES - vascular injury, lacerations

BRAIN/CORD - contusions, lacerations, diffuse axonal injury (DAI) , diffuse vascular injury

Question 2

T/F :Central nervous system (CNS) injury is the leading cause of death in people < 45 years of age in Western countries.

Answer 2

True

Question 3

T/F: CNS injury causes
1% of all deaths
30% of deaths from trauma
50% of deaths due to motor vehicle accidents

Answer 3

True

Question 4

Penetrating injury

Answer 4

direct disruption of tissue

Question 5

Closed injury

Answer 5

movement and compression of neural and vascular structures within bony confines

Question 6

Secondary effects of traumatic injury

Answer 6

Ischaemia
Hypoxia
Cerebral swelling (raised ICP)
Infection
Epilepsy

Question 7

Features of Skull fractures, types and where they occur

Answer 7

Tend to radiate from point of impact, can be depressed, can be open, closed, comminuted (splintering) and can be basal

Question 8

Coup and contrecoup

Answer 8

Coup: at impact site
Contrecoup: Occur when head is not immobilised at the time of injury and involves the opposite side of the brain

Question 9

Where does the sterotypic contusion occur and what is it called?

Answer 9

Base of brain known as basal contusions

Question 10

Healed cerebral contusions

Answer 10

Brain contusions occur at the tips of gyri, and the gyri and sulci become more pronounced as lost tissue is not replaced

Question 11

Lacerations

Answer 11

Penetration by foreign body or skull fragments

Question 12

Missile injuries

Answer 12

Kinetic energy imparted by a bullet is determined by the projectile velocity

Question 13

Vulnerable site of tearing due to sufficient energy transfer

Answer 13

Ponto-medullary junction

Question 14

Diffuse forms of brain injury

Answer 14

Diffuse axonal injury, diffuse vascular injury

Question 15

Axonal swellings

Answer 15

Build up of axonal material that is being transported down the axon (not immediate)

Question 16

Long term effects of diffuse axonal injury

Answer 16

Increased ventricular size, thinned corpus callosum

Question 17

Cord-compressive acute traumatic injury

Answer 17

cord tissue is squeezed both proximally and distally by impaction “toothpase effect”

Question 18

Hydrocephalus

Answer 18

dilated ventricles compresses brain tissue eg blockage of drainage from fourth ventricle

Question 19

Chronic traumatic encephalopathy

Answer 19

• Brain atrophy due to neuronal loss.
• Abnormal deposition of Tau protein.
• Often diffuse deposition of A-beta plaques in cortex

Question 20

Initial response to an expanding brain lesion

Answer 20

expulsion of as much CSF and venous blood as possible. After that, intracranial pressure starts to rise.

Question 21

Where do Herniations of brain tissue occur?

Answer 21

Through Dural openings

Question 22

Two subtypes of cerebral oedema

Answer 22

VASOGENIC – due to blood-brain barrier disruption with increased vascular permeability, mainly involves white matter

CYTOTOXIC – increased INTRAcellular fluid secondary to neuronal, glial or endothelial cell membrane injury. Grey and white matter. Nastier than vasogenic

Question 23

Duret haemorrhages

Answer 23

vessels are fixed so diencephalic herniation causes tearing of these vessels causes brainstem haemorrhages

Question 24

Subfalcine herniation

Answer 24

Cingulate gyrus under falx cerebri

Question 25

Transtentorial herniation

Answer 25

Medial temporal lobe under the tentorium cerebelli

Question 26

Tonsilar Herniation

Answer 26

Cerebellum and brainstem through foramen magnum