Trauma

Question 1

A 27 year-old man was comatose after severe head trauma.

Answer 1

Diffuse axonal injury

Background

• Results from shear forces after trauma (angular rotation, acceleration-deceleration injuries)
• Axons become stretched which leads to swelling

Clinical presentation

• Immediate loss of consciousness
• Comatose, severe cognitive deficits

Imaging

• Restricted diffusion in corpus callosum, brainstem, and gray-white junction
• Multiple small microhemorrhages on MRI
  
  • Most too small to be seen on CT

Question 2

A 43 year-old man with a headache and lethargy after a car accident.

Answer 2

Subarachnoid hemorrhage

• Head trauma is most common cause

Question 3

43 year-old man after trauma.

Answer 3

Cerebral contusion (intraparenchymal hemorrhage)

Background

• Trauma is leading cause
• Orbitofrontal cortex + anterior temporal lobes are common damage sites in acceleration-deceleration injuries
• Coup = contusion at site of impact
• Contracoup = contusion at opposite site of impact

Clinical features

• Loss of consciousness
• Orbitofrontal cortex damage
  
  • Disinhibition and poor executive function
• Temporal damage
  
  • Memory loss
  • Seizures