Pathology of Head Injury Flashcards Preview

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Flashcards in Pathology of Head Injury Deck (23)
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1
Q

Commonest cause of traumatic head injury in the UK?

A

Road traffic accidents and alcohol related incidents including assaults

2
Q

What are the primary and secondary concerns after trauma to the head?

A
  • Primary: focal/diffuse brain trauma

- Secondary: hypotension, hypoxia, infection, haematoma

3
Q

How do scores on the glasgow coma scale correlate with severity of head injury?

A

Score out of 15, 3 the lowest

13-15 - mild injury
9-12 - moderate injury
3-8 - severe injury

4
Q

What are some significant post trauma complications patients may experience

A
  • Permanent physical disability
  • Post traumatic epilepsy
  • Intracranial infection
  • Psychiatric illness
  • Chronic subdural haemorrhage
  • Punch drunk dementia
5
Q

How can a natural disease cause head trauma?

A

Can cause collapse of the patient that results in head injury

6
Q

Describe the relationship of the different layers of meninges to the brain and skull

A
  • Dura: adhered to the inner surface of the skull
  • Arachnoid: envelopes the brain
  • Pia: adhered to surface of the brain, goes into sulci
7
Q

Why is the scalp quite vulnerable to laceration from blunt force impact?

A

Because it is attached to the skull making tearing associated with blunt force impact more likely

8
Q

Types of skull fracture?

A
  • Linear
  • Depressed
  • Comminuted
  • Ring
  • Contre-coup
9
Q

Where do linear skull fractures usually occur?

A

Usually temporo-parietal from fall/blow to side of head

Becomes “hinge” fracture if continues to skull base

10
Q

Describe a depressed skull fracture

Common post-trauma complications?

A

Focal impact pushes skull fragments inwards, damages meninges and blood vessels

Risk of meningitis and post-traumatic epilepsy

11
Q

Describe a comminuted skull fracture

A

Fracture resulting in a fragmented skull

12
Q

Describe a ring skull fracture

A

Fracture around the foramen magnum

Usually due to fall landing on feet, pushes the skull and spine together

13
Q

Describe a contre-coup skull fracture

A

Fracture of the orbital plates caused by a fall onto the back of the head

14
Q

What are the types of intracranial haemorrhage? Where are they located in relation to the skull/meninges?

A
  • Extradural: between dura and skull
  • Subdural: Beneath dura but above arachnoid
  • Subarachnoid: subarachnoid space
15
Q

How does an intracranial haemorrhage result in neurological symptoms/death?

A
  • Increases intracranial pressure (ICP) which compresses the brain causing symptoms
  • Too high an ICP can cause pressure on the brainstem which causes herniation of the cerebellar tonsils into the foramen magnum, causing death
16
Q

What is the most common cause of extradural haemorrhage? Which artery is most often involved with the bleed?

A
  • Skull fracture most common cause (80-90% cases)

- Usually caused by bleeding from middle meningeal artery

17
Q

Which blood vessels are usually torn in subdural haemorrhage? What can put you at risk of these vessels rupturing?

A
  • Emissary veins
  • Atrophic (smaller) brains can cause the veins to get stretched more easily, any rotational/shearing force can make the vessels vulnerable
18
Q

Which type of haemorrhage can be chronic, particularly in the elderly? Often presents as confusion

A
  • Subdural haemorrhage
19
Q

What is the “Lucid Interval”? In what types of haemorrhages can it be seen?

A
  • Lucid interval: victim initially seems to be okay, but can catastrophically deteriorate later
  • Can occur in extradural and subdural haemorrhage
20
Q

Most common cause of subarachnoid haemorrhage?

A

Natural disease - rupture of cerebral artery

21
Q

What does traumatic basal SAH tell you on a forensic report?

A

Blow to upper part of side of neck, causing abrupt rotational movement of the head leading to rupture of vertebro-basilar circulation

22
Q

Causes of intrinsic brain injury?

A
  • Cerebral oedema (can develop in minutes, often malignant, causes raised ICP)
  • Cerebral contusion/laceration: direct mechanical damage to brain substance
23
Q

Other than haemorrhage, what type of CNS damage can trauma do? (badly worded, probably try fix this)

A

Diffuse traumatic axonal injury

Clinically often results in the patient going into comatose, will probably have concussion and maybe retrograde amnesia after trauma

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