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Questions and Answers
What is a common effect of increased ICP on cerebral perfusion pressure and cerebral blood flow?
What is Cushing's Triad characterized by?
What type of brain injury involves physical damage to the brain?
What is the most common type of intercranial hemorrhage?
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What type of injury is characterized by stretching, shearing, or tearing of nerve fibers?
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What type of spinal cord injury occurs at the moment of impact?
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What is spinal cord shock characterized by?
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What is the primary difference between epidural and subdural hematomas?
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What is the primary difference between closed and open head injuries?
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What is a common sign of a skull fracture?
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What type of skull fracture results from high-energy direct trauma to the head with a blunt object?
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What is the most common cause of traumatic brain injuries?
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What is a secondary brain injury?
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What can contribute to further swelling in cerebral edema?
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What can cause increased intracranial pressure (ICP)?
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What is a characteristic of basilar skull fractures?
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Study Notes
Head Injuries
- There are two main types of head injuries: closed head injuries (most common) and open head injuries.
- Closed head injuries are associated with blunt trauma, resulting in skull fractures, focal brain injuries, and diffuse brain injuries, often complicated by increased intercranial pressure.
- Open head injuries involve penetration of the dura mater and cranial contents, often resulting in substantial neurologic deficit and decreased quality of life.
Skull Fractures
- Skull fractures can be open or closed.
- Signs of skull fractures include deformities, visible cracks in the skull, raccoon eyes (bleeding behind the ear), and Battle sign (raccoon eyes or bleeding behind the ear).
- Types of skull fractures include:
- Linear fractures (non-displaced, most common)
- Depressed fractures (result from high-energy direct trauma to the head with a blunt object)
- Basil skull fractures (associated with high-energy trauma, signs include CSF drainage from ears and raccoon or Battle sign)
- Open skull fractures (expose brain tissue to the environment, high mortality rate)
Traumatic Brain Injuries
- Traumatic brain injuries can be primary or secondary.
- Primary brain injuries result from instantaneous impact to the head, while secondary brain injuries result from sequelae of the primary brain injury (e.g., cerebral edema, increased ICP, cerebral ischemia, and hypoxia).
- Motor vehicle crashes are the most common cause of brain injuries.
Cerebral Edema
- Cerebral edema is a result of cerebral vasodilation and trauma.
- It can contribute to further swelling and may not develop until several hours following the injury.
- Low oxygen levels in the blood can aggravate cerebral edema.
Increased Intracranial Pressure (ICP)
- Increased ICP occurs when there is bleeding inside the skull, which can occur between the skull and dura mater, beneath the dura mater, or within the brain tissue.
- Increased ICP decreases cerebral perfusion pressure and cerebral blood flow.
- Signs of increased ICP include:
- Vomiting
- Headache
- Altered mental status
- Seizures
- Cushing's Triad (increased blood pressure, decreased pulse, and irregular respiration)
Focal Brain Injuries
- Focal brain injuries involve specific grossly observable brain injuries, such as cerebral contusions.
- They are different from concussions, which involve physical damage to the brain.
Epidural Hematomas
- Epidural hematomas are an accumulation of blood between the skull and dura mater.
- They result from a blow to the head that produces a linear fracture of the temporal bone, disrupting the middle meningeal artery.
Subdural Hematomas
- Subdural hematomas are an accumulation of blood beneath the dura mater but outside the brain.
- They are the most common intercranial hemorrhage and may or may not be associated with a skull fracture.
Inter Cerebral Hematomas
- Inter cerebral hematomas involve bleeding within the brain tissue itself.
- They have a high mortality rate, even if surgically evacuated.
Subarachnoid Hemorrhages
- Subarachnoid hemorrhages involve bleeding into the subarachnoid space.
- They are characterized by bloody CSF and signs of meningeal irritation.
Diffuse Brain Injuries
- Diffuse brain injuries affect the entire brain.
- Examples include cerebral contusions, caused by a blow to the head or face, and coup-counter coup injuries.
- Diffuse axonal injuries (DAIs) involve stretching, shearing, or tearing of nerve fibers, resulting in consequential axonal damage.
Spinal Injuries
- Spinal injuries can result from compression, flexion, lateral bending, rotation, or vertical compression mechanisms.
- Injuries to the C1 and C2 of the spine are often unstable and result from high-velocity mechanisms.
- Any obvious injury to the head and neck may indicate injury to the cervical spine.
Spinal Cord Injuries
- Primary spinal cord injuries occur at the moment of impact.
- Spinal cord concussion is characterized by temporary dysfunction that lasts from 24 to 48 hours.
- Spinal cord contusion is caused by fracture dislocation or direct trauma.
- Secondary spinal cord injuries result from primary SCI progressing to further deterioration.
Spinal Cord Shock
- Spinal cord shock is a temporary local neurologic condition occurring immediately after spinal trauma.
- It presents with varying degrees of acute spinal injury, and sensory function below the level of injury is impaired.
Head Injuries
- There are two main types: closed head injuries (most common) and open head injuries.
Skull Fractures
- Can be open or closed.
- Signs include deformities, visible cracks in the skull, raccoon eyes, and Battle sign.
- Types of skull fractures:
- Linear fractures (non-displaced, most common)
- Depressed fractures (result from high-energy direct trauma to the head with a blunt object)
- Basil skull fractures (associated with high-energy trauma)
- Open skull fractures (expose brain tissue to the environment, high mortality rate)
Traumatic Brain Injuries
- Can be primary or secondary.
- Primary brain injuries result from instantaneous impact to the head.
- Secondary brain injuries result from sequelae of the primary brain injury.
- Motor vehicle crashes are the most common cause of brain injuries.
Cerebral Edema
- Result of cerebral vasodilation and trauma.
- Can contribute to further swelling and may not develop until several hours following the injury.
- Low oxygen levels in the blood can aggravate cerebral edema.
Increased Intracranial Pressure (ICP)
- Occurs when there is bleeding inside the skull.
- Decreases cerebral perfusion pressure and cerebral blood flow.
- Signs include:
- Vomiting
- Headache
- Altered mental status
- Seizures
- Cushing's Triad (increased blood pressure, decreased pulse, and irregular respiration)
Focal Brain Injuries
- Involve specific grossly observable brain injuries, such as cerebral contusions.
- Different from concussions, which involve physical damage to the brain.
Epidural Hematomas
- Accumulation of blood between the skull and dura mater.
- Result from a blow to the head that produces a linear fracture of the temporal bone, disrupting the middle meningeal artery.
Subdural Hematomas
- Accumulation of blood beneath the dura mater but outside the brain.
- Most common intercranial hemorrhage and may or may not be associated with a skull fracture.
Inter Cerebral Hematomas
- Bleeding within the brain tissue itself.
- High mortality rate, even if surgically evacuated.
Subarachnoid Hemorrhages
- Bleeding into the subarachnoid space.
- Characterized by bloody CSF and signs of meningeal irritation.
Diffuse Brain Injuries
- Affect the entire brain.
- Examples include:
- Cerebral contusions (caused by a blow to the head or face)
- Coup-counter coup injuries
- Diffuse axonal injuries (stretching, shearing, or tearing of nerve fibers)
Spinal Injuries
- Can result from compression, flexion, lateral bending, rotation, or vertical compression mechanisms.
- Injuries to the C1 and C2 of the spine are often unstable and result from high-velocity mechanisms.
- Any obvious injury to the head and neck may indicate injury to the cervical spine.
Spinal Cord Injuries
- Primary spinal cord injuries occur at the moment of impact.
- Spinal cord concussion is characterized by temporary dysfunction that lasts from 24 to 48 hours.
- Spinal cord contusion is caused by fracture dislocation or direct trauma.
- Secondary spinal cord injuries result from primary SCI progressing to further deterioration.
Spinal Cord Shock
- Temporary local neurologic condition occurring immediately after spinal trauma.
- Presents with varying degrees of acute spinal injury, and sensory function below the level of injury is impaired.
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Description
This quiz covers the basics of head injuries, including closed and open head injuries, and skull fractures, their causes, and effects on the brain.
