B&b Week 6: Pathology Of Head/spinal Trauma

Front 1

The injury usually associated with linear fractures

Back 1

* A simple fall

-if unassociated with significant brain injury, or do not lacerate the middle meningeal artery, require little treatment

Front 2

4 Injuries associated with complex fractures and basal hinge fractures

Back 2

1. homicidal attack,
2. vehicular trauma,
3. falls from great heights
4. falls down many non-carpeted stairs onto hard surfaces.

Front 3

Types of Extracerbral intracranial hemorrhages
1. Epidural Hematomas
-Associated injury
-What happens
-Diagnosis

Back 3

*Least common of the 3*

-Fracture of temporal bone with laceration of the middle meningeal artery

-Dura is detached from inner table and produces external compression of the brain

-Difficult. Lucid interval following trauma, but rapidly deteriorates as blood accumulates

Front 4

Types of Extracerbral intracranial hemorrhages
2. Subdural Hematomas
-Associated injury
-Anatomic location
-What initially happens
-Re-bleed risk

Back 4

-Head trauma with uni/bilateral tearing of bridging veins. Seen in most shaken-battered babies, but in this case aren't severe enough to require evacuation

-Located over posterior 2/3 of cerebral hemispheres

-Rapid or slow bleeding causes increase in ICP--> compression--> herniation--> death.

-Blood gets encapsulated in fibro-vasculature. Minor trauma here can cause re-bleeds. May also become calcified

Front 5

Types of Extracerbral intracranial hemorrhages
3. Subarachnoid hemorrhage
-Associated injury
-

Back 5

-head trauma when brain is contused or lacerated

-Occur in isolation or with SDH

Front 6

Contra coup lesions
-Associated injury
-Anatomical location of damage
-Prognosis
-Chronic lesions

Back 6

-single falls; moving head--> stationary object

-Damage in a line 180 from the site of impact; thus usually frontal-temporal lobes

-Alone, not lethal

-Chronic lesions provide focus for later seizures (alcoholics with repeated falls)

Front 7

Coup Lesions
-Associated injury
-Fracture?

Back 7

-Moving object--> stationary head
- +/- overlying fracture

Front 8

Rotational/Angular acceleration head injuries "Closed head"
-When are they seen?
-What happens
-Location of damage
-Gliding contusions
-Axonal damage

Back 8

-helmeted (motor)cyclists; pedestrians hit by cars

-Tearing of vessels and axons in subcortical/deep white matter.

-Usually splenium of corpus callosum, midbrain, and rostral pons at level of locus ceruleus. (sometimes thalamus and basal ganglia)

-primary split of white matter. Mainly in SB infants b/c lots of water in infant white matter

-Diffuse axonal injury: axon swelling; or frank transection forming retraction balls

Front 9

1st Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected

Back 9

* compression of ipsilateral hemisphere herniates the medial portion (ex: C. gyrus) under the falx.

* Herniation can compress the ACA leading to infarct

Front 10

2nd Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected
-Nerve affected

Back 10

*Uncal herniation

*Compresion of PCA leads to infarction of of ventral temporal and occipal lobe

*CN III compression--> important for clinical evaluation

Front 11

3rd Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Areas affected
-Symptoms

Back 11

* Ipsilateral downard compression of brain through tentorial notch leading to transverse displacement of the brainstem

* "Kemohan's notch." Compression of contralateral cerebral peduncle and CN III

* Paresis ipsilateral and pupillary dysfunction contralateral to the lesion

Front 12

4th Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected

Back 12

* Caudal displacement of the brainstem

*Tearing of vessels leading "Durat hemorrhages" in midbrain and upper/mid pons

Front 13

5th Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Areas affected
-Symptoms

Back 13

* Caudal displacement of medulla and cerebellar tonsils through the foramen magnum

*Compression of arterial supply to the medulla--> Ischemic damage to cardio-respiratory control centers

*BP abnormalities, respiratory compromise, and then finally cardiac arrest/death

Front 14

Primary Brainstem Trauma
1. Angular Acceleration
-location of damage
-outcome

Back 14

-Damage to upper pons at locus ceruleus
-rapid death; very rare PVS

Front 15

Persistent Vegetative State
-4 most common locations of damage
-outcome

Back 15

*Any damage to the RAS

1. Tegmentum
2. Nonspecific thalamic nuclei
3. Periaqueductal gray matter
4. Cingulate gyrus

Front 16

Primary Brainstem Trauma
3. Extreme neck hyperextension
-location of damage
-outcome

Back 16

-Transection of ponto-medullary junction
-immediate death
- seen in helmeted cyclists or pedestrians hit by cars

Front 17

Child Abuse in infants
-External injuries and fractures?
-Blunt trauma injury
-Rotational injury
-Shaking/whiplash injury

Back 17

- Usually no external injuries or fractures

- Posterior interhemispheric hematomas and olfactory tract contusions from blunt trauma

- Rotational forces cause glinding contusions, transection of corpus callosum, and/or DAI

-Whiplash and cervical cord damage leads to spinal shock (floppiness). Leads to respiratory compromise thus global asphyxia leading to "black brain" on CT. Can see optic nerve/retinal damage as well.