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Lecture 14

Trauma of the Central Nervous System

What is the leading cause of CNS injury for ages <15 and >65? Falls
What is the leading cause of CNS injury for adolescents and young adults? Motor vehicle accidents
A type of skull fracture distant from the point of the impact and not a direct extension of hte original fracture. Coutercoup fracture
Most common location of contusions (1) inferior surface of the frontal lobes (2) inferior and lateral aspects of the temporal lobes (3) occipital lobes
What vessel is injured in an epidural hematoma? Middle meningeal artery
Why do epidural hematoms necessitate emgergent surgical intervention? Epidural hematomas cause acute compression and displacement of the underlying brain with high morbidity and mortality.
What is the appearance of an epidural hematoma on CT scan? Epidural hematomas have a "lens-shape" or biconvex shape. The hematoma does not cross over suture lines.
What vessels are injured in a subdural hematoma? Bridging veins: veins that travel from the brain surface to the dural sinuses within the subdural space.
What is the appearance of an subdural hematoma on CT scan? The subdural hematoma have a "crescent-shape" mass that crosses over suture lines.
What vessels are injured in a subarachnoid hemorrhage? Cortico-meningeal arteries
What vessels are injured in intraparenchymal hematomas? Small intraparenchymal vessels
A common cause of persistent neurological disability. The injury usually results form mechanical distorition and/or stretching of axonal processes and microvasculature from brain motion. Diffuse Brain Injury
Common locations of diffuse axonal injury (1)cerebral hemisphere white matter (2)corpus callosum (3)subcortical fiber tracts(fornix, internal and external capsules), brain stem
Histological features of diffuse axonal injury (1)axonal retraction balls (2)axonal swelling (3)focal glial scarring in chronic phases
Common locations of diffuse vascular injury Similar locations to diffuse axonal injury: (1)hemispheric white matter (2)corpus callosum (3)brain stem (4) superior cerebellar peduncles
Histologic features of diffuse vascular injury In the acute phase: small (petechial) hemorrhages. In the chronic phase: cystic lesions with glial scarring
(T or F) The extent of injury by a gunshot wound to the head primarily depends on the velocity of the bullet, with higher-velocity bullets causing the greatest amount of damage. True.
(T or F) The exit wound is typically greater than the entrance wound if the barrel of a gun is immediately adjacent to the head. False. The entrance wound is greater than the exit wound if the barrel is against or immediately adjacent to the head.
(T or F) Majority of spinal cord injury victims are males with the median age of 33 years. True. 80% are males and 50% of patients are <25 years.
A focal crush and compression, flexion or extension of hte spinal cord by fracture or fracture dislocation of the spinal cord. Closed spinal cord injuries
Common locations of ischemic brain damage after head trauma (1) hippocampus CA1(Sommer's sector), Purkinje cells of cerebellum (3) Arterial boundry zones (watershed infarcts)
Created by: UVAPATH2