أسئلة السادسة شرعي الدلتا (قبل التعديل)
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Questions and Answers

What is the most common type of skull fracture?

  • Fissure fracture (correct)
  • Penetrating fracture
  • Localized depressed fracture
  • Comminuted fracture

    • Which type of brain injury involves sudden transient loss of consciousness?

  • Cerebral concussion (correct)
  • Contusions and lacerations
  • Compression of the brain
  • Intracranial hemorrhage

    • Which injury is NOT classified as a type of intracranial hemorrhage?

  • Subarachnoid hemorrhage
  • Localized contusion (correct)
  • Subdural hemorrhage
  • Extradural hemorrhage

    • Which skull fracture type involves fissured fragments radiating from a central fracture point?

    <p>Comminuted fracture</p> Signup and view all the answers

    What type of injury typically results in blood and CSF escape from the ear?

    <p>Basal fracture</p> Signup and view all the answers

    What sign is NOT associated with cerebral concussion?

    <p>Bloody nasal discharge</p> Signup and view all the answers

    What type of skull fracture is characterized by involvement with the sagittal suture?

    <p>Fissure fracture</p> Signup and view all the answers

    Which of the following is NOT a direct cause of brain hemorrhage?

    <p>Excessive physical exertion</p> Signup and view all the answers

    What is an indication of complete recovery from a concussion?

    <p>Recovery occurs within 6 hours with no residual signs.</p> Signup and view all the answers

    Which symptom is NOT associated with post-concussion syndrome?

    <p>Nausea</p> Signup and view all the answers

    What happens during the lucid interval after a concussion?

    <p>The patient may regain consciousness temporarily before further decline.</p> Signup and view all the answers

    What is a critical reason for monitoring a patient with a history of concussion for 24-36 hours?

    <p>To record vital signs and check for changes in condition.</p> Signup and view all the answers

    What leads to compression and coma after a concussion?

    <p>Bleeding from a torn vessel after regaining normal blood pressure.</p> Signup and view all the answers

    Which type of injury occurs on the opposite side of the impact during a concussion?

    <p>Contre-coup injury</p> Signup and view all the answers

    What is a sign that decompression surgery may be indicated after a concussion?

    <p>Pulse rate decreases to 60 beats per minute.</p> Signup and view all the answers

    What behavior is characteristic of post-traumatic automatism following a concussion?

    <p>The patient performs voluntary acts but forgets them.</p> Signup and view all the answers

    What is the primary effect of high intracranial pressure on brain function?

    <p>Gradual loss of consciousness</p> Signup and view all the answers

    During the stage of paralysis caused by increased intracranial pressure, what specifically compresses and affects the brain?

    <p>Thick walled cerebral arteries</p> Signup and view all the answers

    What vital sign changes can indicate an increase in intracranial pressure?

    <p>Rapid pulse becoming weaker</p> Signup and view all the answers

    Which symptom is typically associated with an increase in intracranial pressure?

    <p>Projectile vomiting</p> Signup and view all the answers

    What type of injury often leads to tearing of vessels in the subdural space?

    <p>Minor or unnoticed trauma</p> Signup and view all the answers

    Which condition is NOT associated with high intracranial pressure?

    <p>Normal cerebrospinal fluid pressures</p> Signup and view all the answers

    What are the signs of lateralization associated with increased intracranial pressure?

    <p>Unequal pupils</p> Signup and view all the answers

    Which statement accurately relates to the effects of hypertension on the brain?

    <p>It can lead to rupture of bridging veins</p> Signup and view all the answers

    What type of skull fracture is most commonly seen in young persons due to non-union of sutures?

    <p>Fissure fracture</p> Signup and view all the answers

    Which of the following describes a stellate fracture?

    <p>A comminuted fracture with radiating fragments</p> Signup and view all the answers

    Which scenario is least likely to result in a basal skull fracture?

    <p>Fall from a height onto feet</p> Signup and view all the answers

    Which type of intracranial hemorrhage occurs outside the dura mater?

    <p>Extradural hemorrhage</p> Signup and view all the answers

    What symptom is NOT typically associated with cerebral concussion?

    <p>Pupil dilation</p> Signup and view all the answers

    Which mechanism may lead to compression of the brain during a skull fracture?

    <p>Indirect force via the vertebral column</p> Signup and view all the answers

    Which of the following conditions may result from direct application of a force leading to brain injury?

    <p>Hemorrhage</p> Signup and view all the answers

    What is a key identification feature of a signature skull fracture?

    <p>Mirror shape of the striking instrument</p> Signup and view all the answers

    What characterizes post-concussion syndrome?

    <p>Symptoms such as headache, vertigo, and insomnia</p> Signup and view all the answers

    Which of the following best describes retrograde amnesia following a concussion?

    <p>Inability to recall the moment of trauma and preceding events</p> Signup and view all the answers

    What is a consequence of bleeding from a torn middle meningeal artery after a concussion?

    <p>Slow accumulation of blood leading to potential compression and coma</p> Signup and view all the answers

    What is indicated by a decrease in pulse to 60 beats per minute in a concussion patient?

    <p>Need for immediate decompression surgery</p> Signup and view all the answers

    How does a coup injury differ from a contre-coup injury?

    <p>Coup injuries occur at the site of impact while contre-coup occurs opposite</p> Signup and view all the answers

    What behavior is observed in patients experiencing post-traumatic automatism after a concussion?

    <p>Completion of voluntary acts without memory of them</p> Signup and view all the answers

    What observation is essential for a patient with a history of concussion during the first 24-36 hours?

    <p>Regular documentation of vital signs and conscious state</p> Signup and view all the answers

    What is a potential explanation for an individual's capability to mention the assailant after a concussion?

    <p>Residual memory despite overall amnesia</p> Signup and view all the answers

    What happens during the stage of irritation due to high intracranial pressure?

    <p>Blood accumulation causes irritation of cerebral centers.</p> Signup and view all the answers

    Which symptom indicates the stage of paralysis resulting from increased intracranial pressure?

    <p>Cerebral ischemia and paralysis on the same side</p> Signup and view all the answers

    What sequence of signs indicates the progression of increased intracranial pressure?

    <p>Slow pulse to rapid weak, normal to fever, and hypertension to hypotension</p> Signup and view all the answers

    When a traumatic intracranial hemorrhage occurs, which side does contralateral irritation affect first?

    <p>Contralateral irritation happens at the same time as ipsilateral paralysis.</p> Signup and view all the answers

    What type of injury is most commonly associated with tearing of vessels in the subdural space?

    <p>A minor trauma, especially in chronic alcoholics</p> Signup and view all the answers

    Which arteries are primarily affected during the stage of paralysis due to high intracranial pressure?

    <p>Thick-walled cerebral arteries</p> Signup and view all the answers

    What characterizes the progression of the vital signs as intracranial pressure increases?

    <p>Rapid heart rate and breath followed by hypotension</p> Signup and view all the answers

    What might occur concurrently with the increase of intracranial pressure, particularly affecting pupils?

    <p>Unequal pupils may be observed</p> Signup and view all the answers

    What type of fracture is characterized by a mirror-like pattern of the striking surface on the outer table of the skull?

    <p>Signature fracture</p> Signup and view all the answers

    In what situation does indirect violence typically lead to brain injury?

    <p>Falls from height, such as landing on buttocks or feet.</p> Signup and view all the answers

    What is the primary feature of a fissure skull fracture in terms of its structure?

    <p>It is a linear fracture involving the entire thickness of the skull.</p> Signup and view all the answers

    Which symptoms may indicate the presence of a basal skull fracture?

    <p>Escape of blood and CSF from the ear and nose.</p> Signup and view all the answers

    What mechanism leads to an extradural hemorrhage following head injury?

    <p>Tearing of the middle meningeal artery.</p> Signup and view all the answers

    How does cerebral concussion manifest physiologically immediately after the injury?

    <p>There is a sudden transient loss of consciousness and a potential change in EEG.</p> Signup and view all the answers

    What type of intracranial hemorrhage occurs beneath the dura mater?

    <p>Subdural hemorrhage</p> Signup and view all the answers

    What injury results from a blow to the chin and involves indirect force?

    <p>Basal skull fracture</p> Signup and view all the answers

    What does a patient experiencing post-traumatic automatism fail to remember?

    <p>The patient fails to remember actions they performed voluntarily after the accident.</p> Signup and view all the answers

    What is meant by a 'lucid interval' following a concussion?

    <p>A lucid interval refers to an initial recovery period after a concussion before the onset of coma due to compression.</p> Signup and view all the answers

    What role does hypotension play following a torn middle meningeal artery in a concussion case?

    <p>Hypotension prevents immediate bleeding, allowing blood to accumulate gradually until blood pressure normalizes.</p> Signup and view all the answers

    How are coup and contre-coup injuries characterized in relation to impact?

    <p>Coup injuries occur at the site of impact, while contre-coup injuries occur on the opposite side due to brain movement.</p> Signup and view all the answers

    What might prompt the recommendation for a decompression operation in concussion patients?

    <p>A decrease in pulse rate to 60 beats per minute can indicate the need for decompression.</p> Signup and view all the answers

    What is the significance of monitoring vital signs every 15 minutes for a concussion patient?

    <p>Frequent monitoring helps detect early signs of deterioration, such as changes in consciousness or vital signs.</p> Signup and view all the answers

    In the context of concussion, what are the psychological symptoms associated with post-concussion syndrome?

    <p>Headache, vertigo, insomnia, and loss of concentration are key psychological symptoms.</p> Signup and view all the answers

    What types of lesions are observed in coup and contre-coup injuries?

    <p>Lesions may occur on the same side of the trauma (coup) or opposite side (contre-coup).</p> Signup and view all the answers

    What are the primary consequences of progressive intracranial pressure on cerebral function and vital signs?

    <p>Gradual loss of consciousness, projectile vomiting, and altered vital signs including a rapid weak pulse.</p> Signup and view all the answers

    How does the mechanism of injury differ between a coup injury and a contre-coup injury?

    <p>A coup injury occurs at the site of impact, while a contre-coup injury occurs on the opposite side of the impact.</p> Signup and view all the answers

    What is the earliest sign of cerebral irritation due to a hematoma and increased intracranial pressure?

    <p>Gradual blood accumulation leading to cerebral congestion and irritation.</p> Signup and view all the answers

    What role do thick-walled cerebral arteries play during the stage of paralysis from increased intracranial pressure?

    <p>They are compressed by a sufficient-sized hematoma, resulting in cerebral ischemia.</p> Signup and view all the answers

    In cases of traumatic intracranial hemorrhage, which side experiences contralateral irritation initially?

    <p>The contralateral side experiences irritation at the same time as ipsilateral paralysis.</p> Signup and view all the answers

    What is typically indicated by the presence of unequal pupils in a patient with increased intracranial pressure?

    <p>It suggests signs of lateralization and potential brain injury.</p> Signup and view all the answers

    What pathological changes accompany the tearing of vessels in the subdural space?

    <p>It may occur due to minor trauma, especially in individuals with risk factors like aging or alcohol use.</p> Signup and view all the answers

    What vital sign changes might be expected as intracranial pressure escalates in a patient?

    <p>Vital signs may progress from slow, full pulse to rapid, weak pulse and from normal temperature to fever.</p> Signup and view all the answers

    What type of skull fracture is characterized by multiple fissured fragments radiating from a central point?

    <p>Comminuted fracture</p> Signup and view all the answers

    Describe the most common cause of cerebral concussion.

    <p>A direct application of force to the head is the most common cause of cerebral concussion.</p> Signup and view all the answers

    How does a basal skull fracture typically present symptoms?

    <p>Basal skull fractures may present with escape of blood and CSF from the nose or ears.</p> Signup and view all the answers

    What is a typical consequence of a traumatic intracranial hemorrhage?

    <p>Traumatic intracranial hemorrhage can lead to increased intracranial pressure.</p> Signup and view all the answers

    Explain the significance of 'mirror' patterns in skull fractures.

    <p>A 'mirror' pattern in skull fractures helps in weapon identification based on the shape of the striking surface.</p> Signup and view all the answers

    What characterizes a linear fissure fracture?

    <p>A linear fissure fracture involves a crack that may extend through the entire thickness of the skull.</p> Signup and view all the answers

    Name one type of intracranial hemorrhage and its primary location.

    <p>Epidural hemorrhage occurs between the skull and the dura mater.</p> Signup and view all the answers

    What are the common symptoms indicative of increased intracranial pressure?

    <p>Symptoms may include headache, vomiting, and changes in pupil response.</p> Signup and view all the answers

    What occurs in the brain during the stage of irritation associated with high intracranial pressure?

    <p>Gradual blood accumulation leads to pressure on the thin-walled cerebral veins, causing cerebral congestion, edema, and irritation of brain centers on the same side of the lesion.</p> Signup and view all the answers

    What vital sign changes are indicative of increased intracranial pressure?

    <p>Pulse changes from slow and full to rapid and weak, respiration becomes slow and stertorous, and temperature may rise.</p> Signup and view all the answers

    In which scenario might a ruptured bridging vein occur, and what does it signify?

    <p>A ruptured bridging vein often occurs in minor or unnoticed trauma, commonly seen in elderly or chronic alcoholics, indicating potential subdural hematoma.</p> Signup and view all the answers

    What happens when a sufficient-sized hematoma compresses the thick-walled cerebral arteries?

    <p>It leads to cerebral ischemia and paralysis of the brain centers on the same side as the lesion.</p> Signup and view all the answers

    How does contralateral irritation manifest during the progression of increased intracranial pressure?

    <p>Initially, while ipsilateral paralysis occurs, there is contralateral irritation, which later develops into paralysis at the terminal stage.</p> Signup and view all the answers

    What factors can contribute to tearing of vessels in the subdural space?

    <p>Factors like trauma from closed head injuries, fractures of cranial bones, or age-related conditions can contribute to this tearing.</p> Signup and view all the answers

    What are some signs of lateralization that might occur with increased intracranial pressure?

    <p>Signs include unequal pupils, exaggerated reflexes on the contralateral side, and muscle twitches.</p> Signup and view all the answers

    What critical change in vital signs is a possible indicator of severe intracranial pressure complications?

    <p>A drop in pulse combined with increasing hypertension can indicate a serious decline in the patient's condition.</p> Signup and view all the answers

    What are the common symptoms of post-concussion syndrome?

    <p>Symptoms include headache, vertigo, insomnia, and loss of concentration.</p> Signup and view all the answers

    What characterizes a lucid interval following a concussion?

    <p>A lucid interval is marked by a temporary recovery from concussion symptoms before potential progression to coma due to compression.</p> Signup and view all the answers

    What factors in a concussion may lead to the development of retrograde amnesia?

    <p>Retrograde amnesia occurs when a patient forgets the moment of trauma and the period preceding it due to the concussion.</p> Signup and view all the answers

    Describe the mechanism by which post-traumatic automatism may occur.

    <p>Post-traumatic automatism involves a patient performing voluntary acts after an accident but having no memory of those actions.</p> Signup and view all the answers

    What role does monitoring vital signs play for patients with a history of concussion?

    <p>Monitoring vital signs helps to detect any deterioration in condition, particularly fluctuations in pulse, blood pressure, and consciousness.</p> Signup and view all the answers

    What is the potential legal implication for a patient experiencing post-traumatic automatism?

    <p>The patient may not be held legally responsible for actions taken during post-traumatic automatism due to lack of memory.</p> Signup and view all the answers

    Explain how increased intracranial pressure may progress in a patient after a concussion.

    <p>Increased intracranial pressure can lead to symptoms like paralysis and affect vital signs, indicating serious complications.</p> Signup and view all the answers

    How does the tearing of the middle meningeal artery relate to concussion injuries?

    <p>Tearing of the middle meningeal artery during a concussion can lead to accumulation of blood, resulting in compression and potential coma.</p> Signup and view all the answers

    Study Notes

    Forensic Medicine - Head Injuries

    • Classification of Head Injuries:
      • Scalp injuries
      • Skull fractures
      • Meningeal injuries
      • Brain injuries

    Scalp Injuries (Wounds)

    • Types:
      • Contused wound (most common)
      • Cut wound
      • Bruises
      • Firearm injuries
    • Complications:
      • Meningitis
      • Brain abscess
      • Sinus thrombosis
      • Hemorrhage

    Skull Injuries (Fractures)

    • Causes:

      • Direct application of force
      • Indirect violence

    • Factors affecting type of skull fracture:

      • Momentum of the force:
        • Localized striking surface ("hammer head")
        • Very small striking surface ("bullet")
        • Wide striking surface ("block of wood")
        • Heavy sharp instrument
      • Size of striking surface: Different sized surfaces leads to various patterns of fractures
      • Site of the blow: Occipital, frontal, parietal, temporal, office party
      • Support of the head: E.g., sleeping on the ground
      • Covering of the head:

    • Classification:

      • Fissure fracture (linear or "diastatic")
      • Localized depressed fracture
      • Comminuted fracture
      • Cut fracture
      • Penetrating fracture
      • Basal fractures

    Fissure Fracture

    • Characteristics:
      • Most common type of skull fracture
      • Linear fracture involving entire skull thickness, or inner/outer table only.
      • Commonly involves the sagittal suture.
      • Typically seen in young individuals (due to suture structure).

    Localized Depressed Fracture

    • Characteristics: Signature fracture; the injury of the outer table mirroring the shape of the striking instrument

    Comminuted Fracture

    • Characteristics:
      • Fracture with fragmented radiating pieces
      • Often referred to as "spider web"

    Cut Fracture

    • Characteristics: A fracture resulting from a sharp-force object.

    Penetrating Fracture (Hole Fracture)

    • Characteristics: A fracture with a hole.

    Basal Fracture

    • Causes:
      • Indirect trauma (commonest): Fall from height on feet/buttocks, force transmission through the vertebral column.
      • Heavy blow: Face and chin
      • Extension from other fractures (vault fissures): to the base of the brain.
      • Direct trauma by a bullet

    Brain Injuries

    • Classification:
      • Cerebral concussion (sudden loss of consciousness)
      • Contusions and lacerations
      • Compression of the brain
      • Intracranial hemorrhage
        • Extradural/epidural (traumatic)
        • Subdural (acute/chronic)
        • Subarachnoid
        • Intracerebral

    Concussion

    • Definition: State of sudden transient loss of consciousness; from momentary arrest of brain function.
    • Clinical Picture: Sudden loss of consciousness, pale skin, rapid/weak pulse, low blood pressure (hypothermia), and vomiting. Possible uneven pupils and conjugate deviation of both eyes.
    • Fate: Complete recovery (within 6hrs; no residual signs), Incomplete recovery (post-concussion syndrome: headache, vertigo, insomnia, loss of concentration), retrograde amnesia, and post-traumatic automatism. Concussion passes to compression with or without lucid interval potentially leading to coma.
    • Lucid Interval: Period of temporary recovery between coma of concussion, and compression; patient may talk and walk.

    Contusion & Laceration

    • Coup injury: Lesions immediately subjacent to impact site; due to inbending of bone with brain compression.
    • Contrecoup injury: Lesions on the opposite side of the impact site. Occurs due to sudden stoppage of head movement against a hard surface, causing linear and rotational strains; secondary fracture may occur from these strains.

    Cerebral Compression

    • Definition: Loss of consciousness from high intracranial pressure, disrupting brain functions.
    • Traumatic causes:
      • Depressed fracture of skull
      • Traumatic intracranial hemorrhage
    • Mechanism: Gradually increasing ICP affecting thin-walled veins, leading to congestion, edema, irritation of brain centers. As pressure rises, thick-walled arteries are compressed, causing ischemia and paralysis on the same side of the lesion. Opposite side may experience irritation prior to paralysis.

    Sequelae of Head Injuries

    • Post-traumatic sequelae: Post-traumatic amnesia, post-concussion syndrome, Jacksonian epilepsy, permanent infirmity, sepsis (infection), punch drunkness, and cranial nerve palsies.

    Intracranial Hemorrhages

    • Extradural (Epidural): Traumatic, middle meningeal artery injury.
    • Subdural: Tearing of vessels in subdural space - fracture of the cranial bone, closed head injury. Differentiating between acute and chronic subdural hemorrhages.
    • Subarachnoid: Traumatic or pathological, involving rupture of vessels.
    • Intracerebral: Pathological or Traumatic, based on cause and presentation during the initial exam and timeline of the trauma.

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