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 (D)</p> Signup and view all the answers

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

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

What sign is NOT associated with cerebral concussion?

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

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

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

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

<p>Excessive physical exertion (C)</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. (C)</p> Signup and view all the answers

Which symptom is NOT associated with post-concussion syndrome?

<p>Nausea (B)</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. (D)</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. (B)</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. (A)</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 (B)</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. (C)</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. (B)</p> Signup and view all the answers

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

<p>Gradual loss of consciousness (C)</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 (A)</p> Signup and view all the answers

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

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

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

<p>Projectile vomiting (A)</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 (B)</p> Signup and view all the answers

Which condition is NOT associated with high intracranial pressure?

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

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

<p>Unequal pupils (D)</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 (C)</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 (C)</p> Signup and view all the answers

Which of the following describes a stellate fracture?

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

Which type of intracranial hemorrhage occurs outside the dura mater?

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

What symptom is NOT typically associated with cerebral concussion?

<p>Pupil dilation (C)</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 (C)</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 (D)</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 (C)</p> Signup and view all the answers

What characterizes post-concussion syndrome?

<p>Symptoms such as headache, vertigo, and insomnia (D)</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 (A)</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 (C)</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 (B)</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 (A)</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 (B)</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 (A)</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 (D)</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. (A)</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 (B)</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 (B)</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. (A)</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 (C)</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 (D)</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 (D)</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 (D)</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

Flashcards

Scalp injuries

Injuries to the skin and tissues covering the skull

Skull Fractures

Breaks in the skull bone

Meningeal injuries

Damage to the membranes surrounding the brain (meninges)

Brain injuries

Damage to the brain tissue itself

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Contused wound (scalp injuries)

Bruised wound on the scalp, common type of injury

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Meningitis

Inflammation of the meninges, potentially serious

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Cut wound

Open wound on the scalp, leading to bleeding

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Brain abscess

Collection of pus within the brain tissues

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Bruises (scalp injuries)

A discoloration of the skin caused by blood pooling beneath the surface of the skin

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Sinus thrombosis

Blood clot in the brain's blood vessels

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Fissure fracture (skull fracture)

A linear crack in the skull, involving the whole or part thickness

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Localized depressed fracture(skull fracture)

A fracture where section of the skull is driven inward

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Comminuted fracture(skull)

A fracture with many bone fragments

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Cerebral Concussion

Transient loss of consciousness after head injury

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Skull fracture

A break in the skull bone. Often caused by impact.

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Extradural Hemorrhage

Bleeding between the skull and the dura mater

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Subdural Hemorrhage

Bleeding underneath the dura mater

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Subarachnoid hemorrhage

Bleeding in the space between the arachnoid and pia mater membranes

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Intracerebral Hemorrhage

Bleeding within the brain tissue itself

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Head Injury

Damage or injury to the head or brain

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Complete Recovery (Concussion)

Full recovery from a concussion within 6 hours, with no lasting symptoms.

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Incomplete Recovery (Concussion)

Recovery from concussion leading to post-concussion syndrome (PC), a collection of symptoms like headaches and difficulty concentrating.

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Post-concussion Syndrome (PC)

Collection of lingering symptoms following a concussion, including headache, vertigo, sleep problems, and difficulty concentrating.

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Retrograde Amnesia

Loss of memory for events leading up to and including the moment of head trauma.

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Post-traumatic Automatism

Performing voluntary actions after an accident, but with no conscious memory of the actions.

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Concussion to Compression

Progression of head injury from concussion to brain compression, potentially resulting in coma.

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Lucid Interval

Period of temporary awareness and recovery between concussion and a subsequent compression-related coma.

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Coup Injury

Brain injury occurring on the same side of the head as the impact site.

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Contrecoup Injury

Brain injury on the opposite side of the head from the impact site.

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Hospitalization (Concussion)

Recommended for all concussion patients for 24-36 hours of observation, regardless of appearance.

Signup and view all the flashcards

Observation Protocol (Concussion)

Frequent monitoring (every 15 minutes) of vital signs, consciousness, and motor functions in suspected concussion cases.

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Intracranial Pressure (ICP)

Pressure inside the skull, which can increase dangerously and impair brain function if excessive.

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Depressed Skull Fracture

A skull fracture where a part of the skull is pushed inward, potentially damaging underlying brain tissue.

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Traumatic Intracranial Hemorrhage

Bleeding within the skull due to head trauma.

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Stage of Irritation (Head Injury)

Early stage of head injury; characterized by blood accumulation pressing on thin-walled veins, causing cerebral congestion & edema, with irritation of brain centers.

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Stage of Paralysis (Head Injury)

Advanced stage of head injury; characterized by larger hematomas causing pressure on thick-walled arteries, resulting in ischemia and paralysis on brain centers.

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Subdural Hemorrhage

Bleeding between the dura mater and arachnoid, often due to minor trauma or chronic conditions.

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Subarachnoid Hemorrhage

Bleeding in the space between the arachnoid and pia mater layers.

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Projectile Vomiting (Head Injury)

Sudden forceful vomiting, often seen in cases of increasing intracranial pressure.

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Vital Sign Changes (Head Injury)

Changes in pulse (from slow to rapid), respiration (from rapid to slow), temperature (from normal to fever), and blood pressure (from high to low) are possible signs of raised ICp.

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Lateralizing Signs (Head Injury)

Neurological signs indicating a specific brain area is affected, like unequal pupils or abnormal reflexes.

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Gradual loss of consciousness (Head Injury)

Loss of awareness over time, often due to increasing intracranial pressure from head trauma.

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Depressed Skull Fracture

Skull fracture where a section of the bone is pushed inward, potentially damaging the brain.

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Traumatic Intracranial Hemorrhage

Bleeding within the skull caused by head trauma (e.g., bleeding after a blow).

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Stage of Irritation (Head Injury)

Early stage: Blood buildup presses on thin-walled veins, causing brain swelling and irritation.

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Stage of Paralysis (Head Injury)

Advanced stage: Further pressure damages thick-walled arteries. Creates ischemia and paralysis.

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Projectile Vomiting (Head Injury)

Sudden, forceful vomiting, often a sign of increasing intracranial pressure.

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Vital Sign Changes (Head Injury)

Changes in pulse, respiration, temperature, and blood pressure can indicate raised intracranial pressure.

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Lateralizing Signs (Head Injury)

Neurological signs (unequal pupils, reflexes) showing a specific brain area is affected.

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Subdural Hemorrhage

Bleeding between the dura and arachnoid layers (often due to minor trauma).

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Subarachnoid Hemorrhage

Bleeding into the space between the arachnoid and pia mater.

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Complete Recovery (Concussion)

Full recovery from a concussion within 6 hours, with no lasting symptoms.

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Incomplete Recovery (Concussion)

Recovery from concussion leading to post-concussion syndrome (PC), a collection of symptoms like headaches and difficulty concentrating.

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Post-concussion Syndrome (PC)

Collection of lingering symptoms following a concussion, including headache, vertigo, sleep problems, and difficulty concentrating.

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Retrograde Amnesia

Loss of memory for events leading up to and including the moment of head trauma.

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Post-traumatic Automatism

Performing voluntary actions after an accident, but with no conscious memory of the actions.

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Concussion to Compression

Progression of head injury from concussion to brain compression, potentially resulting in coma.

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Lucid Interval

Period of temporary awareness and recovery between concussion and a subsequent compression-related coma.

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Coup Injury

Brain injury occurring on the same side of the head as the impact site.

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Contrecoup Injury

Brain injury on the opposite side of the head from the impact site.

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Hospitalization (Concussion)

Recommended for all concussion patients for 24-36 hours of observation, regardless of appearance.

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Observation Protocol (Concussion)

Frequent monitoring (every 15 minutes) of vital signs, consciousness, and motor functions in suspected concussion cases.

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Scalp Injury

Damage to the skin and tissues covering the skull.

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Skull Fracture

A break in the skull bone.

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Meningeal Injury

Damage to the membranes surrounding the brain (meninges).

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Brain Injury

Damage to brain tissue itself.

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Contused Wound

A bruised wound on the scalp, a common type of injury.

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Meningitis

Inflammation of the meninges, potentially serious.

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Cut Wound

An open wound on the scalp, leading to bleeding.

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Brain Abscess

Collection of pus within the brain tissues.

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Bruises(scalp)

Discoloration of skin due to blood pooling beneath the surface.

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Sinus Thrombosis

Blood clot in brain's blood vessels.

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Fissure Fracture

Linear crack in skull, involving its layers.

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Localized Depressed Fracture

Fracture where a part of the skull is pushed inward.

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Comminuted Fracture

Skull fracture with many bone fragments.

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Cerebral Concussion

Transient loss of consciousness after head injury.

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Epidural Hemorrhage

Bleeding between skull and dura mater.

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Subdural Hemorrhage

Bleeding beneath dura mater.

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Subarachnoid Hemorrhage

Bleeding in space between arachnoid and pia mater.

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Intracerebral Hemorrhage

Bleeding inside brain tissue.

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Head injury

Damage or injury to the head or brain.

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Complete Concussion Recovery

Full recovery from a concussion within 6 hours, with no lasting symptoms.

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Incomplete Concussion Recovery

Recovery from concussion leading to post-concussion syndrome (PC), a collection of symptoms like headaches and difficulty concentrating.

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Post-concussion Syndrome (PC)

Collection of lingering symptoms following a concussion, including headache, vertigo, sleep problems, and difficulty concentrating.

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Retrograde Amnesia

Loss of memory for events leading up to and including the moment of head trauma.

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Post-traumatic Automatism

Performing voluntary actions after an accident, but with no conscious memory of the actions.

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Concussion to Compression

Progression of head injury from concussion to brain compression, potentially resulting in coma.

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Lucid Interval

Period of temporary awareness and recovery between concussion and a subsequent compression-related coma.

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Coup Injury

Brain injury occurring on the same side of the head as the impact site.

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Contrecoup Injury

Brain injury on the opposite side of the head from the impact site.

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Hospitalization (Concussion)

Recommended for all concussion patients for 24-36 hours of observation, regardless of appearance.

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Observation Protocol (Concussion)

Frequent monitoring (every 15 minutes) of vital signs, consciousness, and motor functions in suspected concussion cases.

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Gradual loss of consciousness (Head Injury)

Loss of awareness over time, often due to increasing intracranial pressure from head trauma.

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Depressed Skull Fracture

A skull fracture where a section of the bone is pushed inward, potentially damaging the brain.

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Traumatic Intracranial Hemorrhage

Bleeding within the skull caused by head trauma (e.g., bleeding after a blow).

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Stage of Irritation (Head Injury)

Early stage: Blood buildup presses on thin-walled veins, causing brain swelling and irritation.

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Stage of Paralysis (Head Injury)

Advanced stage: Further pressure damages thick-walled arteries. Creates ischemia and paralysis.

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Projectile Vomiting (Head Injury)

Sudden, forceful vomiting, often a sign of increasing intracranial pressure.

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Vital Sign Changes (Head Injury)

Changes in pulse, respiration, temperature, and blood pressure can indicate raised intracranial pressure.

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Lateralizing Signs (Head Injury)

Neurological signs (unequal pupils, reflexes) showing a specific brain area is affected.

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Subdural Hemorrhage

Bleeding between the dura and arachnoid layers (often due to minor trauma or chronic conditions).

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Subarachnoid Hemorrhage

Bleeding into the space between the arachnoid and pia mater.

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Scalp injury

Damage to the skin and tissues covering the skull.

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Skull fracture

A break in the skull bone, often from a blow.

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Meningeal injury

Damage to the membranes surrounding the brain.

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Brain injury

Damage to the brain tissue itself.

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Contused wound

A bruised wound on the scalp, a common type of injury.

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Meningitis

Inflammation of the meninges (membrane covering the brain and spinal cord).

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Cut wound

An open wound on the scalp leading to bleeding.

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Brain abscess

Collection of pus within the brain tissue.

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Bruise (scalp)

Discoloration of the skin due to blood pooling beneath the surface.

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Sinus thrombosis

Blood clot in blood vessels within the brain.

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Fissure fracture

A linear crack in the skull, involving the whole or part thickness.

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Localized depressed fracture

A fracture where a section of the skull is pushed inward.

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Comminuted fracture

Skull fracture with many bone fragments.

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Cerebral concussion

Transient loss of consciousness after a head injury.

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Epidural Hemorrhage

Bleeding between the skull and the dura mater.

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Subdural Hemorrhage

Bleeding beneath the dura mater.

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Subarachnoid Hemorrhage

Bleeding into the space between the arachnoid and pia mater.

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Intracerebral Hemorrhage

Bleeding within the brain tissue itself.

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Scalp injury

Damage to the skin and tissues covering the skull.

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Skull fracture

A break in the skull bone, often caused by impact.

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Meningeal injury

Damage to the membranes surrounding the brain.

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Brain injury

Damage to brain tissue itself.

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Contused wound

A bruised wound on the scalp, a common injury type.

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Meningitis

Inflammation of the meninges.

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Cut wound

Open wound on the scalp leading to bleeding.

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Brain abscess

Collection of pus within the brain tissue.

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Bruise

Discoloration of skin due to blood pooling beneath.

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Sinus thrombosis

Blood clot in brain's blood vessels.

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Fissure fracture

Linear crack in the skull, involving its layers.

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Localized depressed fracture

Fracture where a part of the skull is pushed inward.

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Comminuted fracture

Skull fracture with many bone fragments.

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Cerebral concussion

Transient loss of consciousness after head injury.

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Epidural hemorrhage

Bleeding between skull and dura mater.

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Subdural hemorrhage

Bleeding beneath dura mater.

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Subarachnoid hemorrhage

Bleeding between arachnoid and pia mater.

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Intracerebral hemorrhage

Bleeding inside brain tissue.

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Complete Concussion Recovery

Full recovery within 6 hours without lasting symptoms

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Incomplete Concussion Recovery

Recovery with post-concussion syndrome (PC)

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Post-concussion Syndrome (PC)

Lingering symptoms after concussion (headache, vertigo, etc.)

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Retrograde Amnesia

Loss of memory before and at the time of trauma

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Post-traumatic Automatism

Performing actions without memory of them after trauma

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Concussion to Compression

Head injury progressing to brain compression

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Lucid Interval

Temporary recovery period between concussion and compression

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Coup Injury

Brain injury on the same side of the impact

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Contrecoup Injury

Brain injury opposite to the impact site

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Concussion Hospitalization

All concussion patients need 24-36 hours of observation

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Concussion Observation Protocol

Regular monitoring of vital signs, consciousness, and motor functions

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Gradual loss of consciousness (Head Injury)

Loss of awareness over time, often due to increasing pressure inside the skull (intracranial pressure) from head trauma.

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Depressed Skull Fracture

A skull fracture where a section of the skull is pushed inward, potentially damaging the brain.

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Traumatic Intracranial Hemorrhage

Bleeding within the skull caused by head trauma.

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Stage of Irritation (Head Injury)

Early stage of head injury; characterized by blood accumulation pressing on thin-walled veins, causing cerebral congestion and edema, with irritation of brain centers.

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Stage of Paralysis (Head Injury)

Advanced stage of head injury; characterized by larger hematomas causing pressure on thick-walled arteries, resulting in ischemia and paralysis on brain centers.

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Projectile Vomiting (Head Injury)

Sudden forceful vomiting, often seen in cases of increasing intracranial pressure.

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Vital Sign Changes (Head Injury)

Changes in pulse (from slow to rapid), respiration (from rapid to slow), temperature (from normal to fever), and blood pressure (from high to low) can indicate raised intracranial pressure.

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Lateralizing Signs (Head Injury)

Neurological signs indicating a specific brain area is affected, like unequal pupils or abnormal reflexes.

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Subdural Hemorrhage

Bleeding between the dura mater and arachnoid, often due to minor trauma or chronic conditions.

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Subarachnoid Hemorrhage

Bleeding in the space between the arachnoid and pia materlayers.

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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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Forensic Lecture 6 (Head Injuries) PDF

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