Spinal Cord Injuries and Head Trauma Quiz

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Questions and Answers

What is a primary characteristic of locked-in syndrome?

Loss of sensory perception

Inability to swallow

Severe damage to the brainstem (correct)

Breathing difficulties

Which factor does NOT contribute to spinal cord injuries?

Diving accidents

Excessive hydration (correct)

Falls

Sport-related injuries

What type of spinal cord injury is most commonly observed in clinical practice?

Closed spinal cord injuries (correct)

Degenerative spinal injuries

Open spinal cord injuries

Complete spinal cord injuries

Which description accurately represents a predictor of survival following a spinal cord injury?

Age at the time of injury Signup and view all the answers

Which mechanism can lead to cervical cord injuries specifically linked to infant abuse?

Whiplash injuries from shaking Signup and view all the answers

What percentage of head injury attendees in Ireland are considered to have minor injuries?

90% Signup and view all the answers

Which age group has the highest percentage of head injury cases in Ireland?

Children Signup and view all the answers

What is the most common cause of death among young adults in developed countries?

Head injuries Signup and view all the answers

Which type of trauma is associated with incised wounds on the scalp?

Sharp Force Trauma Signup and view all the answers

What is the estimated number of new brain injuries occurring annually in Ireland?

19,000 Signup and view all the answers

What percentage of head injuries is associated with fatal outcomes?

0.2% Signup and view all the answers

What role does the sub-arachnoid space play in head injuries?

It provides a cushion and leeway for expansion. Signup and view all the answers

Which of the following is NOT a common cause of head injuries among young individuals?

Routine medical procedures Signup and view all the answers

What is the primary risk associated with scalp injuries?

Acute blood loss Signup and view all the answers

Which type of skull fracture is typically caused by a simple fall?

Linear fracture Signup and view all the answers

What risk factors influence the likelihood of sustaining a skull fracture from a blunt force trauma?

Thickness of hair and scalp Signup and view all the answers

Which type of fracture is most commonly associated with the middle meningeal artery injury?

Extradural fracture Signup and view all the answers

What is a possible complication of a basal skull fracture?

Cerebrospinal fluid leakage Signup and view all the answers

What characterizes the lucid interval in patients with extradural hemorrhage?

A period of consciousness followed by rapid decline Signup and view all the answers

What is a coup contusion?

Contusion at the exact site of impact without fracture Signup and view all the answers

Which injury is associated with fractures and can include tears in the meninges?

Meningeal injury Signup and view all the answers

What factor is NOT associated with increased severity of skull fractures?

Individual's height Signup and view all the answers

Which type of contusion is commonly associated with impact to the occipital region?

Contre-coup contusion Signup and view all the answers

What are retraction balls associated with?

Acceleration/deceleration injuries Signup and view all the answers

What is the primary risk associated with a burst lobe from intracerebral hemorrhage?

Usually fatal outcome Signup and view all the answers

Which type of injury is characterized by brain shearing and rotational forces?

Diffuse axonal injury (DAI) Signup and view all the answers

What physiological condition results from an increase in brain water content due to injury?

Cerebral edema Signup and view all the answers

Impact to which part of the head is most likely to cause severe injury to the front of the brain?

Back of the head Signup and view all the answers

What can result from raised intracranial pressure (ICP)?

Cerebral ischemia Signup and view all the answers

What is typically the source of bleeding in a subdural haemorrhage?

Bridging veins Signup and view all the answers

Which factor does NOT contribute to the classification of a subdural haemorrhage?

Indication of misalignment Signup and view all the answers

What type of injury is commonly associated with subarachnoid haemorrhage?

Shearing or rotational injury Signup and view all the answers

Which demographic is particularly vulnerable to subdural haemorrhage due to potential trauma?

Elderly individuals Signup and view all the answers

What characterizes a minor subarachnoid haemorrhage?

Indication of concussion or 'knocking out' Signup and view all the answers

Which type of brain injury is often a result of rotational forces?

Diffuse brain injury Signup and view all the answers

What is a potential effect of secondary brain damage after injury?

Brain swelling Signup and view all the answers

What is the typical consequence of contusions on the brain's surface?

Bruising and potential haematoma formation Signup and view all the answers

What compensatory mechanism involves the movement of cerebrospinal fluid out of the skull due to increased intracranial pressure?

Displacement of CSF Signup and view all the answers

Which of the following is a potential cause of brainstem injuries?

Brain herniation Signup and view all the answers

What effect does alcohol intoxication have on outcomes related to traumatic brain injury?

Worsens outcome even with minor head trauma Signup and view all the answers

Which clinical feature is commonly associated with brainstem injuries?

Irregular breathing Signup and view all the answers

What is one of the potential secondary damages following a severe head injury?

Pulmonary edema Signup and view all the answers

What are the main functions attributed to the midbrain?

Regulates eye movements Signup and view all the answers

Which condition is most likely to cause hypoxic damage following a traumatic brain injury?

Cardiac arrest Signup and view all the answers

What alteration in reflexes may occur as a result of a brainstem injury?

Loss of reflexes Signup and view all the answers

Study Notes

Head Injuries - Learning Outcomes

Describe various types of scalp injuries
Describe the types and complications of skull fractures
Describe the types and pathology of brain haemorrhage
Describe the features and types of cerebral contusion
Describe the causes and pathology of diffuse axonal injury
Describe the pathophysiology of raised intracranial pressure
Describe the types and effects of brain swelling
Describe the pathology of alcohol-related head injury

Significance of Head Injuries

Clinical
Pathological
Legal

Head Injuries (H.I.) Statistics

Head injury is the most common cause of attendance to A&E in Ireland.
90% of all head injury attendees are minor.
40-50% of head injury cases involve children.
Minor head injury rarely associates with long-term complications.
0.2% of head injury cases are fatal, usually severe injuries

Head Injury in Ireland Statistics

19,000 new brain injuries annually
10,000 people hospitalised with traumatic brain injuries annually
8,000-8,500 new strokes annually
300 new brain tumours per annum
120,000 people affected with disabilities after brain injury

Head Injuries (H.I.) Pathological Significance

Commonest cause of death in young adults in developed countries.
50% of deaths in 15–19-year-olds
Leading causes of this death are accidents, suicide, and homicide

The Central Nervous System

The skull protects the brain and spinal cord.
The amount of force a blow is dependent on many factors.

Cross-section of Skull and Meninges

The subarachnoid space contains cerebrospinal fluid (CSF) acting like a cushion.
CSF allows for expansion of the brain.

Spectrum of Injuries

Surface (scalp/face)
Skull
Meninges (dura mater, arachnoid)
Brain

Injury to Face or Scalp

Blunt force trauma: bruises, abrasions, imprints (e.g. from stamping), lacerations (linear or specific, e.g., hammer)
Sharp force trauma: incised wounds, stab wounds

Complications for Scalp Injuries

Haemorrhage - scalp is highly vascular. Death can result from acute blood loss, obstructions in the airway.
Fractured skull.
Bleeding around the brain (extradural, subdural, subarachnoid)

Any Surface Injury May Cause...

Injury to the brain itself: contusions, lacerations, hemorrhage
Diffuse damage: hypoxia, axonal injury, edema

Skull Fractures

Fractures: simple, compound
Indicate amount of force used.
Not necessarily life-threatening

Types of Skull Fractures

Linear: simple fall
Comminuted: more force, scalp damage
Depressed: typically direct blow
Basilar: fall from height, RTA
Ping-Pong: neonates
Diastatic: along skull sutures.

High-Velocity Impact, Flat Impacts Skull Fractures

High-velocity impact: penetrating or depressed fractures.
Flat impacts: linear, non-displaced fractures.

Risk of Skull Fractures with Blunt Force Trauma

Severity of blow
Speed of impact
Object involved (weight, shape, consistency)
Thickness of hair, scalp, skull
Age of victim
Elasticity and brittleness of bone

Complications of a Skull Fracture

CSF leakage (basal fractures)
Infections
Extradural haemorrhage
“Black eyes”/”panda eyes” (frontal fracture)

The Meninges

Meninges injuries: tears associated with fractured skulls, hemorrhage, with or without fracture.

Extradural Haemorrhage

Blood between skull and dura.
Commonly associated with the petrous temporal bone (above or behind the ear).
May occur with no fracture (especially in children)

Meningea Injury (EDH) Source of Bleeding

Arterial: middle meningeal artery (most common)
Venous: diploic channels of skull, small veins

Meningea Injury (EDH) Details

High mortality
50% associated with intracerebral bleeding
Treatable, but intellectual/emotional disability if treatment delayed.
Problems: falls, accelerated falls (e.g., assault associated with alcohol in young males), lucid interval (conscious period, then collapses and dies within hours)

Subdural Haemorrhage

Blood between dura and arachnoid.
Classification: acute, subacute (3–14 days), chronic (>14 days)
Source of bleeding: bridging veins, occasionally venous sinuses
May not be obvious during physical examination or surgery

Subdural Haemorrhage – Additional Information

Elderly, alcoholics
Children: "shaken baby" syndrome, birth-related injury
Whiplash injury.

Subdural Haemorrhage (SDH) – Problems

Less clearly associated with impact injury
Not necessarily associated with fracture (shearing forces)
Can take several hours for symptoms, slow evolution (venous bleed)

Subarachnoid Haemorrhage

Blood over the brain’s surface, beneath the arachnoid membrane.
Causes: tearing of pial vessels between brain and arachnoid, shearing or rotational injury.

Subarachnoid Haemorrhage – Minor/Significant SAH

Minor SAH: indication of head injury, may have been concussed or knocked out
Significant SAH: severe trauma, damage to neck/vertebral arteries, aneurysm rupture, extension of intracranial bleed.

TSAH - Vertebral Arteries

Basal SAH: transmural tear of vertebral artery (usually without pre-existing pathology)
Biomechanically and temporally consistent evidence of blunt impact
Hyperextension and/or rotation of head and neck (e.g., DD: non-traumatic rupture from intracranial vertebral artery dissection; abnormal vessel)

Localized injuries
Generalized/diffuse injuries
Depends on type of H.I., direct force, rotational forces, acceleration/deceleration

Brain Damage

Primary damage:
Sustained at time of impact
Cortical contusions and lacerations
Diffuse axonal/vascular injury
Secondary damage:
Early: hypoxia, ischemia, brain swelling, intracranial hematoma formation
Late: epilepsy, infection

Localized Brain Injury - Surface Injuries

Fracture contusion: directly under a bone fracture
Coup contusion: no fractures, contusion at site of impact
Contrecoup Contusion: bruising at opposite side of impact with possible occipital trauma

Brain - Surface Injuries

Impact front of head: few injuries
Impact top of head: injury of base of brain
Impact side of head: injury sides of brain, worsens opposite side
Impact back of head: injury at back, severe injury front of brain

Brain – Secondary Injury (Intracerebral Haemorrhage)

Usually surface injuries, small bleed
Burst lobe is usually fatal
Differential diagnosis: spontaneous intracerebral haemorrhage (associated with hypertension, specific sites)

Brain - Internal Injury

Deep intracerebral hemorrhage
Indirect injury
Associated with head movement (e.g., RTA)
Due to tearing of vessels
In young individuals, may not be associated with external damage

Brain - Internal Injury (Diffuse/Generalized Damage)

Primary damage: diffuse axonal injury (DAI), diffuse vascular injury (DVI)

DAI/DVI (Diffuse Axonal/Vascular Injury) Causes

Acceleration/deceleration
Shearing/Rotational forces
RTA
Falls from height
Simple falls/assaults

DAI-Brain

Gliding contusions (brain rubs against projecting/hard surfaces)
Hemorrhage in corpus callosum + brainstem (dorsolateral quadrants)

Secondary Damage from Generalized/Diffuse Cerebral Injury

Cerebral edema (characterized by increased brain water content, occurs in response to brain insult, increases brain volume → raised intracranial pressure (ICP), raises ICP → decreases cerebral perfusion pressure – leading to cerebral ischemia, oedema may result in brain herniation)

Cerebral Oedema

Vasogenic, Cytotoxic/Ionic/Cellular, Interstitial/Hydrocephalic, Osmotic/Hypostatic, Hydrostatic

Brain Swelling

Separate entity from cerebral edema, often simultaneous to cerebral insult.
Due to engorgement of cerebral vessels with increased intravascular blood volume, which may lead to cerebral edema
May be delayed (particularly in children)

Raised Intracranial Pressure (ICP)

Causes: localized mass lesions (extra, sub, intracerebral hemorrhage), obstruction of major venous sinuses (fractures, thrombosis), focal edema (trauma, infection, tumor), diffuse edema (injuries, SAH, meningitis, near drowning), neoplasms, abscess, CSF circulation disturbances (obstructive & communicating hydrocephalus, idiopathic intracranial hypertension)

Clinical Features of Raised ICP

Headache
Mental state alteration (lethargy, irritability, abnormal social behavior)
Vomiting
Pupillary changes (unilateral ptosis, third and sixth cranial nerve palsies)
Fundoscopy (papilledema, flame-shaped hemorrhages)
Retinal hemorrhages (care needed with lumbar puncture)

Raised Intracranial Pressure (ICP) Compensatory Mechanisms

Displacement of blood
Displacement of CSF
Loss of brain tissue

Raised Intracranial Pressure (ICP) Mechanisms (Diagram)

Increase pressure in skull → pushes fluid out → cerebral edema & displacement → pressure on brainstem → hemorrhage → herniation

Other Secondary Damages

Hypoxic damage (facial injuries – inhaling blood, blood loss from injuries, cardiac arrest), Seizures, severe head injury (pulmonary edema, gastric erosions, acute pancreatitis)

Cause of Death

Brain damage
Raised intracranial pressure
Associated injuries
Hemorrhage
Inhalation
Bronchopneumonia
IHD (etc.)

Alcohol & Head Injuries

Many accidents/assaults occur in settings of excessive alcohol intake
35-81% of individuals with TBI were intoxicated before the injury. 42% were heavy drinkers.
Intoxication: worsens outcome even with relatively minor head trauma
Muscle laxity, feel "unprotected" when falling

Concussion Details & Complications

Concussion: period of post-injury apnea is lengthened by alcohol intoxication
Recurrent falls: chronic subdural hemorrhages
End-stage liver disease: coagulation disorders

Brainstem And Spinal Cord Injuries

Function: midbrain (eye movements), pons (facial movements, hearing/balance), medulla oblongata (breathing, heart rhythm, blood pressure, swallowing)

Causes of Brainstem Injury

Inflammation (encephalitis)
Vascular (thromboemboli, occlusions, trauma, hypertension)
Traumatic brain injury (herniation)
Falls, Sudden cardiac death
Tumors

Clinical Features of Brainstem Injury

Loss of reflexes, balance, gait issues
Impaired vision, dizziness, loss of sense of smell, altered heart rate/irregular breathing
Paralysis, coma.

Effects of Brainstem Injury

Coma: network of neurons (RAS)
Locked-in syndrome: severely damaged brainstem
Swallowing problems
Respiratory issues
Sensory problems

Spinal Cord Injuries - Causes

Compression damage (falls, hyperflexion/hyperextension, road traffic collisions)
Assaults
Diving accidents
Sport related injuries

Spinal Cord Injury Categorization

Complete
Incomplete

Cervical Cord and Cervicomedullary Injuries

Features of non-accidental whiplash
Age at time of injury, neurological status, injury extent are predictors of survival
Closed SCIs are most common traumatic cord lesions in clinical practice, associated with fracture/dislocation of spine due to hyperflexion/hyperextension movements, compressive forces (fall) or rotational movements (fractures/dislocations)

Spinal Cord Injuries - Additional Information

Cervical or cervicomedullary injuries can follow non-accidental whiplash from shaking infants
Fracture of the spinal column can result in direct compression of the spinal cord, which can be visualized through cross-sections of cervical spinal cord, showing central hemorrhagic infarction after a contusional spinal injury

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Test your knowledge on spinal cord injuries and head trauma with this comprehensive quiz. Explore key characteristics, predictors of survival, demographics of head injury cases, and mechanisms of injury. Perfect for students and professionals in healthcare and rehabilitation fields.