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12 Cards in this Set

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Away from the impact Ex: Frontal lobes get beat up a lot (if one falls and hits back of head, the brain will also bounce against the frontal bones & hit the orbit, same happens with temporal lobes as they smash into sphenoid wings
Anywhere in between
1.Very rare event 2.Occur with calvarian vault fracture (not basal)-->usually with tear in meningeal artery or b/c of bone bleed (there can be big venous pools in the bone…and can bleed a lot more than arterial bleed.) 3.Strips dura away from skull-->it is very hard to strip dura away from suture-->epidural hematomas are limited to sutures-->usually lens shaped, convex into the brain-->pts. that are asymptomatic may sometimes not be operated on, yet they are watched CLOSELY
1.NOT impeded by sutures. Found b/w dura & arachnoid membrane. Frequently seen in older people, since there is more room within the skull (brain shrinks with age). Brain can be bruised & bleed and cause subdural hematoma. It can be arterial or venous. 2.Blood can get in and settle over tentorium 3.Blood can also settle interhemispherically (In subdural hematoma, clots are often present. Clot can NOT be suctioned out & must be operated on)
Acute Blood is white, Old chronic blood is dark!
1.Entire lobe (Parenchyma + bld vessels) is broken apart 2.Lots of edema present-->intracranial HTN 3.Mixture of edema & diffuse blood right over bone
CT Scan shows: 1.Punctate contusion (little dots) or CT scan maybe normal 2.ICP monitor shows normal pressure inside of brain Cause: Sheared axons injury-->stretched hemorrhages show axons have been broken, therefore connections are broken Along with normal CAT scan and pressure also look for severe neurological impairment!
Concussion: "to shake" Brain is shaken about midbrain Midbrain contains the reticular formation (imp for consciousness) KNOW: CAT scan looks normal, MRI looks normal, Pressure is normal-->Concussions are not picked up by imaging! Cause is unknown but maybe fiber bundles are stretched, but not broken
1.Another type of diffuse injury 2.Subarachnoid blood seen in sulci of brain 3.Can also be seen in cisterns 4.Differential aneurysm-->Now we need to determine whether an aneurysm caused the bleed-->CTA or MRA or Conventional angiogram can help
Treated with a graft to reattach bone flat
99% of time goes away by itself (treat by head elevation of 30 degrees)
Venous bleeds can be fixed with bone wax.
There is debate about how long it takes to heal (but patient DOES recover)
Should they get antibiotics? Dr.Bill does NOT give antibiotics (majority don't), others do. If patient has fever, he/she is tapped and then treated with antibiotics if needed (treated symptomatically, leak on its own NOT treated). But we DO NOT send them home; they MUST be watched so that they get on antibiotics AS SOON as needed. These leaks can be immediate or delayed. (Delayed-->swelling that closes off all of these fractures & then a month down the road they start leaking.)
Concern: Bld tinted watery fluid (Bld + CSF=watery) Other fractures Eyes Sense of smeall Naso-gastric tube: BE CAUTIOUS! To not stick a tube that may go in through a fracture and get into brain, use oro-gastric tube instead (through the mouth) Delayed CSF leak: see pt. back in office, could start pt. on antibiotics Air-->anytime air is seen inside of the head in imaging it is indicative of basal skull fracture-->it will be reabsorbed as long as leak is not persistent
*Is there CSF otorrhea or rhinorrhea (Eustachian tube)? *Hemotympanun or just blood in ear canal? (Usually tearing inside ear canal itself, reduced hearing-->conduction defect b/c canal is full of bld & swollen) *External ear canal? *Assess & following hearing-usually some loss due to swelling *Facial nerve damage-->possible lower nerve palsy
Worry about CN7, CN8 which go through the internal acoustic meatus. Also equilibrium (Organ of Corti) compromised
(Belongs above) 3 causes of epidural hematomas: 1.skull f(x) with tear of branch of the middle meningeal a. or meningeal br of the vertebral a. 2.bleeding from f(x)'d skull 3.bleeding from torn venous sinus adjacent to skull f(x)
1.Starts as a linear fracture that tears the dura. 2.Initial linear fracture is usually seen in abused children 3.X-rays are the best method to see these linear fractures. Do NOT use CT scan first (unless CT scan is perpendicular to plane of linear f(x))-->CT scan can miss the initial linear fracture 4.CT scan of growing cephalohematoma (goose egg on side of head). There is a tear of dura present, but it can NOT be seen in the initial CAT scan 5.An intact dura is a good shield for brain pulsations (which happen with every beat of the heart!) Fractures with torn dura will pulsate & eventually skull can open (in children) pushing arachnoid out. (Mother came in later and stated that the big bump on the child's head was pulsating)
Can be in a stellate pattern.
1.Injury caused by beer bottle. Full thickness of skull sunken through. Higher magnification of brain shows bruising (coup contusion). Acute blood looks white with dark edema around it! 2.Venous Phase Angiogram (side view of skull in x-ray): Shows depressed skull. Superior sagittal sinus can be seen (flow of blood is being slowed due to injury)
(Leakage of spinal fluid into nose) (CSF can go into mastoid air cells and get into nose through Eustachian Tube)
(Leakage of spinal fluid into ear)
At site of the impact Ex CT scan: Cephalohematoma seen, coup contusion (seen as little blood clot), could have problems with optic radiations (patient ended up doing fine).