Trauma I

Question 1

Cerebral Edema= excessive ____ in the brain

Answer 1

fluid

Question 2

—Vasogenic Edema:

• —Disrupted ____-____ _____
• —Examples – around hemorrhages and tumors; infections

Answer 2

blood brain barrier

Question 3

—Cytotoxic Edema:

• —Increased _______ fluid
• —Example – hypoxic/ischemic injury, osmotic disequilibrium – dialysis or _____, _____-osmotic states - SIADH

Answer 3

—Cytotoxic Edema:

• —Increased intracellular fluid
• —Example – hypoxic/ischemic injury, osmotic disequilibrium – dialysis or DKA, hypo-osmotic states - SIADH

Question 4

—Interstitial Edema:

• —Increased ______ (ventricular) pressure pushes fluid across _____layer
• —Example – area adjacent to enlarged _____ in hydrocephalus

Answer 4

—Interstitial Edema:

• —Increased intracranial (ventricular) pressure pushes fluid across ependymal layer
• —Example – area adjacent to enlarged ventricles in hydrocephalus

Question 5

With edema morphology, the brain is _____ and ____.

Answer 5

With edema morphology, the brain is enlarged and softened.

Question 6

As a result of edema morphology, the following can occur:

• —Increased intracranial pressure
• —Flattening of ______
• —Compression of ventricular cavities
• —Herniation
• —Neurologic symptoms
• —Headaches
• —Vomiting
• —Papilledema

Answer 6

As a result of edema morphology, the following can occur:

• —Increased intracranial pressure
• —Flattening of gyri
• —Compression of ventricular cavities
• —Herniation
• —Neurologic symptoms
• —Headaches
• —Vomiting
• —Papilledema

Question 7

What does this image show?

Answer 7

cerebral edema:

An acute stroke (left) is characterized by edema. The infarcted side is larger than the opposite hemisphere.

Question 8

what does this image show?

Answer 8

Cerebral Edema:

cerebral abcesses surrounded by edema

Question 9

What does this image show?

Answer 9

The edema appears as a dark rim around the central tumor on CT.

Question 10

Mechanism of herniation: —_____brain pushes brain through ____

Answer 10

Mechanism of herniation: —expanding brain pushes brain through opening

Question 11

What are the consequences of the mechanism of herniation?:

• —_____ of structures/deficits
• —Vascular compromise
• —Ischemia
• —Hemorrhage

Answer 11

What are the consequences of the mechanism of herniation?:

• —Compression of structures/deficits
• —Vascular compromise
• —Ischemia
• —Hemorrhage

Question 12

—Transtentorial Herniation:

• —Supratentorial lesion forces brain through ______ notch
• —Compression of _____ nerve
• —Duret hemorrhage in midbrain/upper ___ secondary to downward displacement of the______ (and fixed penetrating vessels)
• —Compression of opposite cerebral _____ (Kernohan notch)

Answer 12

—Transtentorial Herniation:

• —Supratentorial lesion forces brain through tentorial notch
• —Compression of 3rd nerve
• —Duret hemorrhage in midbrain/upper pons secondary to downward displacement of the brainstem (and fixed penetrating vessels)
• —Compression of opposite cerebral peduncle (Kernohan notch)

Question 13

—Subfalcian herniation:

• —Lateral cerebral hemisphere lesion forces brain under ____
• —Compression of _____ cerebral arteries possible

Answer 13

—Subfalcian herniation:

• —Lateral cerebral hemisphere lesion forces brain under falx
• —Compression of anterior cerebral arteries possible

Question 14

—Cerebellar tonsillar herniation:

• —Often secondary to ______ _____lesion
• —Brain forced down through foramen _____
• —_____centers compromised – Apnea and death

Answer 14

—Cerebellar tonsillar herniation:

• —Often secondary to posterior fossa lesion
• —Brain forced down through foramen magnum
• —Respiratory centers compromised – Apnea and death

Question 15

What does this image show?

Answer 15

Uncal herniation is seen with supratentorial masses forcing the uncal region down through the tentorial notch.

Question 16

What does this image show?

Answer 16

Tonsillar herniation

Question 17

What does this image show?

Answer 17

Duret Hemmorhage:

As the uncus and brainstem are pushed downward, penetrating vessels become stretched and break. This leads to hemorrhages in the upper pons, Duret hemorrhages, that can be fatal.

Question 18

What does this image show?

Answer 18

Duret hemorrhage

Question 19

What type of trauma is a gunshot through the brain?

Answer 19

penetrating

Question 20

What type of trauma is it when the head strikes the floor or a dashboard?

Answer 20

Blunt trauma

Question 21

What type of trauma is it when the skull is disrupted?

Answer 21

open trauma

Question 22

What type of trauma is it when the skull is intact and you have internal lesions?

Answer 22

closed trauma

Question 23

A concussion is what type of injury?

Answer 23

Parenchymal

Question 24

Contusion is what type of injury?

Answer 24

parenchymal

Question 25

Laceration is what type of injury?

Answer 25

parenchymal

Question 26

Diffuse axonal damage is what type of injury?

Answer 26

Parenchymal

Question 27

Hematomas are what type of injury?

Answer 27

vascular damage injury

Question 28

Do concussions have physical damage?

Answer 28

no

Question 29

What is contusion?

Answer 29

bruising

Question 30

Types of contusion: ## Footnote —Coup –\_\_\_\_ lesion —Contrecoup – on \_\_\_\_\_side of brain

Answer 30

Types of contusion: —Coup – **_under l_**esion —Contrecoup – on **_opposite_** side of brain

Question 31

Shearing of axons can occur through ____ or \_\_\_

Answer 31

acceleration or deceleration

Question 32

What areas are most at risk for axonal damage?

Answer 32

midline white matter areas (around corpus callosum)

Question 33

Diastatic fractures occur across \_\_\_\_

Answer 33

sutures

Question 34

—Basilar fractures – At ____ of brain; can lead to ____ eyes (pooling of blood around eyes/orbit) or \_\_\_\_\_hematomas; ____ cranial nerves can be compromised

Answer 34

—Basilar fractures – At **_base_** of brain; can lead to **_raccoon_** eyes (pooling of blood around eyes/orbit) or **_mastoid_** hematomas; **_lower_** cranial nerves can be compromised

Question 35

—Concussion * Follows trauma with no _____ physical damage * —Damage/changes may be \_\_\_\_\_\_\_ * —Associated with brief loss of consciousness and transient amnesia * —Severity varies from very mild to severe * —Much attention with sports injuries * —Repeated concussions increase chance of permanent brain damage.

Answer 35

—Consussion * Follows trauma with no **_observable_** physical damage * —Damage/changes may be **_biochemical_** * —Associated with brief loss of consciousness and transient amnesia * —Severity varies from very mild to severe * —Much attention with sports injuries * —Repeated concussions increase chance of permanent brain damage.

Question 36

—Contusion * —Bruise with local vascular damage and resultant ischemia; worse at _____ of gyri * —Occurs at area of injury (coup) or opposite to area of injury (contrecoup) often opposite areas of rough/irregular skull (e.g. base of ____ and \_\_\_\_lobes) * —Coup (at site of injury) often occur when head is _____ and receives a blow * —Contrecoup (opposite site of injury) often occur when head is _____ and collides with surface. * Often ____ lesions are often present.

Answer 36

—Contusion * —Bruise with local vascular damage and resultant ischemia; worse at **_crests_** of gyri * —Occurs at area of injury (coup) or opposite to area of injury (contrecoup) often opposite areas of rough/irregular skull (e.g. base of **_temporal_** and **_frontal_** lobes) * —Coup (at site of injury) often occur when head is **_immobile_** and receives a blow * —Contrecoup (opposite site of injury) often occur when head is **_mobile_** and collides with surface. Often **_coup_** lesions are often present.

Question 37

What do these images show?

Answer 37

contusions

Question 38

What does this image show?

Answer 38

Acute contusions show evidence of the hemorrhages. Contrecoup lesions are often located on the temporal horns or inferior frontal lobes (i.e. opposite rough and irregular skull).

Question 39

— Epidural vascular injury/hemorrhage: * Tear of middle meningeal artery by \_\_\_\_\_skull fracture * —Increase in volume and possible herniation and death more \_\_\_\_than other forms; often following _____ interval

Answer 39

Epidural vascular injury/hemorrhage: * Tear of middle meningeal artery by **_temporal_** skull fracture * —Increase in volume and possible herniation and death more **_rapid_** than other forms; often following **_lucid_** interval

Question 40

—Subdural vascular injury/hemorrhage * —Tear of\_\_\_\_\_\_\_veins (cortex to sagittal sinus) * —More common in _____ (greater distance between brain and sinus) * —Accumulation of blood _____ than epidural * —Bilateral chronic subdurals can be associated with \_\_\_\_\_

Answer 40

—Subdural vascular injury/hemorrhage * —Tear of **_bridging_** veins (cortex to sagittal sinus) * —More common in **_elderly_** (greater distance between brain and sinus) * —Accumulation of blood **_slower_** than epidural * —Bilateral chronic subdurals can be associated with **_dementia_**

Question 41

—Subarachnoid/Intraparenchymal vascular injury/hemorrhage * —With contusions and lacerations * —Secondary to tearing of _____ blood vessels

Answer 41

—Subarachnoid/Intraparenchymal vascular injury/hemorrhage * —With contusions and lacerations * —Secondary to tearing of **_small_** blood vessels

Question 42

What does this image show?

Answer 42

epidural hemorrhage

Question 43

What does this image show?

Answer 43

Subdural Hemorrhage

Question 44

What does this image show?

Answer 44

Subarachnoid Hemorrhage