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17 Cards in this Set

  • Front
  • Back
The injury usually associated with linear fractures
* A simple fall

-if unassociated with significant brain injury, or do not lacerate the middle meningeal artery, require little treatment
4 Injuries associated with complex fractures and basal hinge fractures
1. homicidal attack,
2. vehicular trauma,
3. falls from great heights
4. falls down many non-carpeted stairs onto hard surfaces.
Types of Extracerbral intracranial hemorrhages
1. Epidural Hematomas
-Associated injury
-What happens
*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
Types of Extracerbral intracranial hemorrhages
2. Subdural Hematomas
-Associated injury
-Anatomic location
-What initially happens
-Re-bleed risk
-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
Types of Extracerbral intracranial hemorrhages
3. Subarachnoid hemorrhage
-Associated injury
-head trauma when brain is contused or lacerated

-Occur in isolation or with SDH
Contra coup lesions
-Associated injury
-Anatomical location of damage
-Chronic lesions
-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)
Coup Lesions
-Associated injury
-Moving object--> stationary head
- +/- overlying fracture
Rotational/Angular acceleration head injuries "Closed head"
-When are they seen?
-What happens
-Location of damage
-Gliding contusions
-Axonal damage
-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
1st Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected
* compression of ipsilateral hemisphere herniates the medial portion (ex: C. gyrus) under the falx.

* Herniation can compress the ACA leading to infarct
2nd Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected
-Nerve affected
*Uncal herniation

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

*CN III compression--> important for clinical evaluation
3rd Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Areas affected
* 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
4th Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Arteries affected
* Caudal displacement of the brainstem

*Tearing of vessels leading "Durat hemorrhages" in midbrain and upper/mid pons
5th Event when increased ICP from a unilateral lesion
-Parencyhmal movement
-Areas affected
* 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
Primary Brainstem Trauma
1. Angular Acceleration
-location of damage
-Damage to upper pons at locus ceruleus
-rapid death; very rare PVS
Persistent Vegetative State
-4 most common locations of damage
*Any damage to the RAS

1. Tegmentum
2. Nonspecific thalamic nuclei
3. Periaqueductal gray matter
4. Cingulate gyrus
Primary Brainstem Trauma
3. Extreme neck hyperextension
-location of damage
-Transection of ponto-medullary junction
-immediate death
- seen in helmeted cyclists or pedestrians hit by cars
Child Abuse in infants
-External injuries and fractures?
-Blunt trauma injury
-Rotational injury
-Shaking/whiplash injury
- 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.