Craniofacial Trauma

Front 1

presentation of fx of temporal bone fx

Back 1

deafness, facial nerve palsies, vertigo, dizziness, nystagmus

Front 2

types of temporal bone fx
most common

Back 2

longitudinal - parallels the petrous bone ** most common
transverse - perpendicular to petrous bone
mixed - combination of above

Front 3

what is usually injured in epidural hematoma

Back 3

meningeal artery most often
occassionally, dural venous sinus disruption can cause venous epidural hematoma

Front 4

associated injury in epidural hematoma

Back 4

85-95% have skull fx

Front 5

where do venous epidural hematomas generally occur

Back 5

vertex
posterior fossa
anterior aspect of middle cranial fossa

Front 6

when can epidural hematomas cross midline

Back 6

if they are at the vertex (in which case, most likely inovlve the superior sag sinus)

Front 7

what is usually injured in subdural hematoma

Back 7

stretching of tearing of cortical veins

Front 8

appearance of subacute subdural hematoma
timeframe

Back 8

isodense to brain parenchymam
occurs svl days - 3 wks following event

Front 9

what is injured in SAH

Back 9

small subarachnoid vessels

Front 10

mechanisms of IVH

Back 10

rotationally induced tearing of subependymal veins on surface of ventricles

direct extension of parenchymal bleed into vents

retrograde flow of SAH into vents via 4th ventriclular outflow foramen

Front 11

appearance of DAI

Back 11

if non-hemorrhagic, will see small foci of increased T2, +/- low T1

if hemorrhagic, will see central low T2 and high T1 within a few days (from intracellular methb)

Front 12

location of DAI

Back 12

near GWJ es p of parasagittal regions of frontal lobes and periventricular regions of temp lobes

CC

Front 13

mechanism of DAI

Back 13

shear injury from decel-accel injury

Front 14

what part of the brain is involved in cortical contusions

Back 14

superficial grey matter, near bony protuberences of skull and skull base

Front 15

CT appearance of cortical contusions

Back 15

depends on age
initally, will see a lrg amt of edema in non-hem lesions
if hemorrhagic, will see areas of high attenuation within gray matter

during first week, can see a salt-and-pepper pattern of mixed high and low density

Front 16

appearance of cortical contusion on MR

Back 16

increased T2 and SWI
often have gyral morphology

Front 17

what structures are considered subcortical gray matter

Back 17

thalamus
basal ganglia
pineal gland
hypothalamus
pituitary gland

Front 18

most common location for subcortical gray matter injury

Back 18

basal ganglia and thalamus --> multiple petechial hemorrhages, resulting from disruption of multiple small perforating vessels

Front 19

which artery is most commonly injured in association with skull base fx

Back 19

internal carotid artery (esp at sites of fixation - entrance to entrance of petrous portion and exit from cavernous sinus below anterior clinoid process)

Front 20

pathogenesis of CC fistula

Back 20

often follows full thickness arterial injury or from ruptured cavernous carotid aneurysm

Front 21

pathophys of dural fistula

Back 21

laceration of middle meningeal artery with resultant formation of fistual connecting meningeal artery to meningeal vein

Front 22

potential complication of subfalcial herniation

Back 22

ACA infarctioin in distribution of callosomarginal branch, as it can become trapped against falx

Front 23

what is effaced in uncal herniation

Back 23

ambient cistern and lateral aspect of suprasellar cistern

Front 24

complications of uncal herniation

Back 24

mass effect on CN III and compression ofcontralateral cerebral peduncle --> blown pupil with ipsilateral hemiparesis

can occassionally result in peduncular hemorrhage or infarction

Front 25

what is effaced in descending transtentorial herniation

Back 25

effacement of suprasellar and perimesencephalic cisterns

Front 26

what can cause ascending transtentorial hernation

Back 26

lrg posterior fossa hematoma

Front 27

which type of transtent herniation is most common

Back 27

descending

Front 28

most common form of brainstem injury

which part of brainstem is most commonly affected

Back 28

DAI

dorsolateral aspect of midbrain and upper pons
superior cbl peduncles

Front 29

what can cause ascending transtentorial hernation

Back 29

lrg posterior fossa hematoma

Front 30

which type of transtent herniation is most common

Back 30

descending

Front 31

most common form of brainstem injury

which part of brainstem is most commonly affected

Back 31

DAI

dorsolateral aspect of midbrain and upper pons
superior cbl peduncles

Front 32

another name for leptomeningeal cyst

pathophys

Back 32

"growing fx"

traumatic tear in dura --> outpouching of arachnoid to occur at site of suture or skull fx -->" progressive, slow widening skull fx 2/2 pulsations.

Front 33

what is almost 100% of the time assoc with brainstem DAI

Back 33

frontal and temporal white matter/CC DAI

Front 34

what must brainstem DAI be distinguished from

Back 34

primary injury caused by direct impact of free margin of the tentorium on brainstem (will not see additional lesions supratentorially)

multiple petechial hemorrhages in periaqueductal regions of rostral brainstem, not assoc with DAI (2/2 disruption of penetrating brainstem BV by shear strain, poor prognosis)

Front 35

complications of uncal herniation

Back 35

brainstem compression

Front 36

duret hemorrhage
pathophys

Back 36

a 2/2 brainstemp injury:

midline hematoma in tegmentum of rostral pons and midbrain, assoc with desencing transtent hernation.
occurs 2/2 stretching or tearing of penetrating arteries as brainstem is caudally displaced

Front 37

how to distinguish a primary vs secondary brainstem injury

Back 37

primary injuries are dorsolateral and 2ndary are ventral or ventrolat

Front 38

most common etiology of low density extra-axial fluid collections in children

how do these pts present, course ?

Back 38

benign enlargmeent of subarachnoid space of infancy

occur in neurologically intact infants, who have enlarging head circumference at 3-6 mo; usually regresses by 2 yo

Front 39

most common intra-axial manifestation of head injury from child abuse

Back 39

diffuse brain swelling, caused by vasodilation and assoc with loss of autoregulation

Front 40

what are the 4 views usually botained in facial bone series

Back 40

caldwell veiw
shallow waters view
cross table laterla
submental vertex view

Front 41

potential complication of nasal fx

Back 41

septal hematoma (2/2 to trauma of septal cartilage)
hematoma forms between perichondrium adn cartilage --> cartilage necrosis by disrupting vascular supply

--> SOB

--> septal abscess formation

Front 42

complication of open frontal sinus fx

Back 42

csf rhinorrhea and recurenta meningitis or abscess

Front 43

potential complication of sphenoid sinus fx

Back 43

vascular injury to cavernous segment of ICA

Front 44

which type of orbital fx is most commonly associated with herniation of orbital contents

sx?

Back 44

blowout fx

vertical diplopia

Front 45

what do all LeFort fxs have in common

Back 45

pterygoid plates are fx in all types

Front 46

Describe Le Fort 1 fx

Back 46

"floating palate"
horizontal fx through max sinus

extends through nasal septum and walls of max sinus, into inferior aspect of pterygoid plates

Front 47

LeFort 2

Back 47

"pyramidal" fx

begins at bridge of nose and extends through nasal septum, frontal process of maxilla, medial wall of orbit, inf orbital rim, sup, lat, and post walls of max antrum, and midportion of pterygoid plates

zygomatic arch and laterla orbital walls are intact

Front 48

what is LeFort 2 fx assoc with

Back 48

posterior displacement of facial bones
infraortibtal nerve often injured

Front 49

LeFort 3

Back 49

"craniofacial dysjxn"
begins near nasofrontal suture and extends posteriorly to nasal septum, medial and lateral orbital walls, zygomatic arch, and base of pterygoid plates

Front 50

mechanism of nasoethmoidal fx

Back 50

blow to midface btwn eyes

Front 51

fxs that are considered nasoethmoidal fx

Back 51

fx of lamina papyracea
inf, med, supraorbital rims
frontal or ethmoid sinuses
orbital roof
nasal bone

Front 52

complications of nasoethmoidal complex fx

Back 52

CSF leak if assoc with dural laceration
olfactory nerve injury