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?

    <p>Age at the time of injury (D)</p> Signup and view all the answers

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

    <p>Whiplash injuries from shaking (A)</p> Signup and view all the answers

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

    <p>90% (C)</p> Signup and view all the answers

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

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

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

    <p>Head injuries (B)</p> Signup and view all the answers

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

    <p>Sharp Force Trauma (A)</p> Signup and view all the answers

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

    <p>19,000 (A)</p> Signup and view all the answers

    What percentage of head injuries is associated with fatal outcomes?

    <p>0.2% (B)</p> Signup and view all the answers

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

    <p>It provides a cushion and leeway for expansion. (D)</p> Signup and view all the answers

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

    <p>Routine medical procedures (C)</p> Signup and view all the answers

    What is the primary risk associated with scalp injuries?

    <p>Acute blood loss (C)</p> Signup and view all the answers

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

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

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

    <p>Thickness of hair and scalp (C)</p> Signup and view all the answers

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

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

    What is a possible complication of a basal skull fracture?

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

    What characterizes the lucid interval in patients with extradural hemorrhage?

    <p>A period of consciousness followed by rapid decline (C)</p> Signup and view all the answers

    What is a coup contusion?

    <p>Contusion at the exact site of impact without fracture (C)</p> Signup and view all the answers

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

    <p>Meningeal injury (C)</p> Signup and view all the answers

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

    <p>Individual's height (D)</p> Signup and view all the answers

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

    <p>Contre-coup contusion (A)</p> Signup and view all the answers

    What are retraction balls associated with?

    <p>Acceleration/deceleration injuries (A)</p> Signup and view all the answers

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

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

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

    <p>Diffuse axonal injury (DAI) (A)</p> Signup and view all the answers

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

    <p>Cerebral edema (D)</p> 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?

    <p>Back of the head (B)</p> Signup and view all the answers

    What can result from raised intracranial pressure (ICP)?

    <p>Cerebral ischemia (B)</p> Signup and view all the answers

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

    <p>Bridging veins (C)</p> Signup and view all the answers

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

    <p>Indication of misalignment (C)</p> Signup and view all the answers

    What type of injury is commonly associated with subarachnoid haemorrhage?

    <p>Shearing or rotational injury (B)</p> Signup and view all the answers

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

    <p>Elderly individuals (C)</p> Signup and view all the answers

    What characterizes a minor subarachnoid haemorrhage?

    <p>Indication of concussion or 'knocking out' (A)</p> Signup and view all the answers

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

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

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

    <p>Brain swelling (B)</p> Signup and view all the answers

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

    <p>Bruising and potential haematoma formation (B)</p> Signup and view all the answers

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

    <p>Displacement of CSF (C)</p> Signup and view all the answers

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

    <p>Brain herniation (B)</p> Signup and view all the answers

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

    <p>Worsens outcome even with minor head trauma (D)</p> Signup and view all the answers

    Which clinical feature is commonly associated with brainstem injuries?

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

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

    <p>Pulmonary edema (B)</p> Signup and view all the answers

    What are the main functions attributed to the midbrain?

    <p>Regulates eye movements (A)</p> Signup and view all the answers

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

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

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

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

    Flashcards

    Head injury types

    Head injuries vary in severity, from minor surface injuries to severe brain damage.

    Scalp/Facial Injuries

    These are injuries to the outer layers of the head. These can result from blunt force trauma, abrasions, or lacerations (cuts).

    Skull Fractures

    Breaks in the skull bone. These can range from simple cracks to more severe injuries, and lead to potential brain damage.

    Brain Hemorrhage

    Bleeding in the brain, caused by damaged blood vessels.

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    Cerebral Contusion

    Bruising of the brain tissue, often from a blow to the head.

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    Diffuse Axonal Injury

    Damage to the brain's nerve pathways, often caused by shaking or a severe impact.

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    Raised Intracranial Pressure

    Increased pressure inside the skull.

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    Brain Swelling

    Brain tissue expanding, potentially causing further damage.

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    Scalp Injury Complications

    Scalp injuries can lead to severe blood loss (hemorrhage), potentially obstructing airways, and fractured skulls.

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    Skull Fracture Types

    Variations include linear, comminuted, depressed, and basilar, each suggesting different impact forces and mechanisms.

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    Extradural Hemorrhage

    Bleeding between the skull and dura mater. Often caused by a ruptured artery (common middle meningeal); can occur without a fracture.

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    Meningeal Injury

    Damage to the meninges (protective membranes) involving tears or hemorrhage, often associated with skull fractures.

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    High Velocity Impact

    Skull injury caused by high-speed impacts. Resulting in penetrating or depressed fractures.

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    CSF Leakage

    Cerebrospinal fluid leakage through a skull fracture, particularly a basal fracture.

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    EDH Lucid Interval

    A short period of consciousness after head injury, followed by unconsciousness and (potentially) death.

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    Subdural Hemorrhage

    Blood accumulation between the dura and arachnoid membranes surrounding the brain.

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    Subarachnoid Hemorrhage

    Bleeding into the space between the arachnoid and pia mater.

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    Acute Subdural Hemorrhage

    Bleeding within hours of injury, often from bridging veins.

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    Chronic Subdural Hemorrhage

    Bleeding over 14 days, often in elderly or alcoholic individuals.

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    Basal SAH (Subarachnoid Hemorrhage)

    Subarachnoid hemorrhage associated with a tear in a vertebral artery at the base of the skull.

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    Localized Brain Injury

    Damage to a specific area of the brain, often from direct impact.

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    Contusion

    Bruising of the brain tissue, often from direct impact.

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    Primary Brain Damage

    Damage that happens during or immediately after the injury.

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    Coup Contusion

    A bruise on the brain directly at the impact site.

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    Contrecoup Contusion

    A bruise on the brain opposite the impact site caused by the brain bouncing back against the skull.

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    Deep Intracerebral Hemorrhage

    Bleeding deep inside the brain, often caused by head movement or shaking.

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    Diffuse Axonal Injury (DAI)

    Widespread damage to nerve fibers in the brain, caused by stretching or shearing forces.

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    Gliding Contusions

    Bruises on the brain caused by friction against bony structures during brain movement.

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    Cerebral Edema

    Swelling in the brain caused by an increase in water content, often due to brain injury.

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    Raised Intracranial Pressure (ICP)

    Increased pressure inside the skull, often caused by cerebral edema.

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    Brain Herniation

    The displacement of brain tissue due to increased intracranial pressure.

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    What is a Coma?

    A state of prolonged unconsciousness caused by damage to the brain's reticular activating system (RAS), which controls alertness and wakefulness.

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    What is Locked-in Syndrome?

    A condition where a person is fully aware but unable to move or communicate due to severe brainstem damage.

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    What are some common causes of spinal cord injuries?

    Common causes include falls, car accidents, assaults, diving accidents, and sports injuries, often resulting in compression, hyperextension or hyperflexion of the spinal cord.

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    What are the two main categories of spinal cord injuries?

    Spinal cord injuries are classified as either complete, where there is a complete loss of function below the injury, or incomplete, where some function remains.

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    What is a cervicomedullary injury?

    An injury that affects both the cervical spinal cord and the brainstem, often seen in cases of non-accidental whiplash injuries in infants.

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    What can happen if ICP isn't treated?

    Uncontrolled raised ICP can lead to herniation, where the brain tissue is squeezed through the skull's opening, causing severe damage and death.

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    How does alcohol worsen head injury?

    Alcohol intake increases the risk of severe head injuries, reduces protective reflexes, and makes complications more likely.

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    Why are brainstem injuries serious?

    The brainstem controls vital functions like breathing, heart rate and swallowing. Damage to it can be fatal.

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    What are the signs of a brainstem injury?

    Signs include impaired vision, breathing difficulties, changes in heart rate, loss of balance, and paralysis.

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    What are some causes of brainstem injuries?

    Brainstem injuries can be caused by trauma, infections, strokes, tumors, and sudden cardiac death.

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    What are the potential consequences of head injury?

    Head injuries can result in brain damage, raised ICP, hypoxic damage, and associated injuries like fractures, blood loss, and infections.

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    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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    Description

    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.

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