Trauma of the CNS Flashcards Preview

Brain and Behavior Part 2 > Trauma of the CNS > Flashcards

Flashcards in Trauma of the CNS Deck (29)
Loading flashcards...
1
Q

anatomy of skull to brain (list layers)

A
scalp
periosteum of outer table
 inner table (fused to outer table)
potential epidural space
dura mater
potential subdural space
arachnoid
subarachnoid space (contains blood vessels and CSF)
pia mater
brain
2
Q

general rules for trauma

A

1) extent of external lesion is not reliable indicator of deeper lesions
2) lethal lesions of skull/brain may be small or absent

3
Q

where can soft tissue injuries occur

A

may be external on face or scalp
or
maybe internal - subepithelial, galeal or periosteal

4
Q

what are the 5 kinds of fractures that occur in skull?

A
linear
compound
complex
depressed
contrecoup
5
Q

what is a linear fracture?

A

secondary to contact with large flat object - fracture begins along inner table–> usually not lethal

6
Q

what is a compound fracture?

A

fx associated with scalp laceration

7
Q

what is complex fracture?

A

fx involving multiple bones

8
Q

what is depressed fracture?

A

secondary to contact with small objects

9
Q

what is contrecoup fracture>?</p>

A

located distant from point of injury

10
Q

what typically causes a hinge fracture?</p>

A

auto accident - it is gaping fracture extending across entire base

11
Q

> what are the two types of dural hematomas? How are they different?</p>

A

epidural - b/w skull and dura & arterial bleeding

subdural - below dura & venous bleeding

12
Q

how does brain change in response to epidural hematoma?

A

compression! Caused by epidural blood - accurate rapid dx for immediate evacuation is mandatory to ensure survival

13
Q

which is more serious epidural or subdural hematoma?

A

epidural

14
Q

describe the pathogenesis of SDH

A

caused by motion of brain with respect to skull and dura tearing bridging veins
typically located over cerebral convexities
increased risk in people w/ brain atrophy
tears of veins more likely with rapid acceleration/deceleration

15
Q

what is the most common traumatic lesion of brain?

A

contusion/laceration

often associated with brain swelling

16
Q

what are the types of contusions/lacerations? (3)

A

1) fracture C/l - at site of fracture and tend to be severe
2) coup contusion - caused by bending/rebounding of skull at site of injury w/ or w/o fracture
- moving object striks stationary but movable head
3) contre coup contusion - located distant, usually opposite point of impact

17
Q

what are the two mechanism of contre coup contusions?

A

1) impact - moving head strikes fixed object

2) impulsive loading- head set in motion or moving head is stopped without being struck or impacted

18
Q

where are contre coup contusions most common?</p>

A

orbito-frontal surfaces & temporal bones - where brain contacts skull

19
Q

do contusions cause seizures?

A

yes

20
Q

what typically causes closed head injuries?

A

severe angular acceleration forces

most common in pedestrian-bike-vehicular impracts, helmeted cyclists, shaken babies

21
Q

what are 3 types of diffuse brain injury?

A

diffuse axonal
concussion
brain swelling

22
Q

what is typical distribution of lesions secondary to angular acceleration?

A
parasagittal white matter
corpus collosum
septum pellicudum/fornix
deep grey
superior cereballar peduncle
23
Q

what are retraction balls?

A

hallmark of diffuse axonal injury - swelling in axons due to build up of transport materials b/c cytoskeleton is damaged

24
Q

describe pathophys effects of severe concussion

A

hallmark of diffuse axonal injury - swelling in axons due to build up of transport materials b/c cytoskeleton is damaged
elevated ca2+ –> neuronal cell death
elevated lactic acid

25
Q

what can cause ischemic brain damage?

A

concussion (causes swelling)
hypotension-cardiac arrest
status epilepticus

26
Q

what occurs after transection of brainstem secondary to hyperextension?

A

death instantaneously

27
Q

basic stats about abusive CNS trauma in infants/children

A

65% of abused I/C die of CNS trauma

28
Q

how common is SDH in shaken infants?

A

80 - 90% of infants who are shaken have SDH –> usually not deadly

29
Q

what are common injuries of shaken babies?

A
SDH
transection of corpus collosum
gliding contusion
transection of spinal cord
optic nerve sheath hemorrhages
black brain