20 Questions
What is a significant cause of death and disability mentioned in the text?
Trauma to the brain and spinal cord
What is the effect of the severity and site of injury on the outcome?
It affects the outcome
What type of injury may cause an open or a closed injury?
A blunt blow to the head
What can occur in the absence of external signs of head injury?
Severe brain damage
What type of injury can occur at the site of impact or opposite the site of impact?
Both coup and contrecoup injury
What is caused by rapid tissue displacement, disruption of vascular channels, and subsequent hemorrhage, tissue injury, and edema?
A contusion
What is the shape of contusions?
Wedge-shaped
What appears as depressed, retracted, yellowish brown patches involving the crests of gyri?
Old traumatic lesions
What is the result of CNS trauma directly disrupting vessel walls?
Hemorrhage
What is the possible location of hemorrhage due to traumatic vascular injury?
Epidural, subdural, or subarachnoid
Where do subarachnoid and intraparenchymal hemorrhages most often occur?
At sites of contusions and lacerations
Which vessel is most vulnerable to traumatic injury in epidural hematomas?
Middle meningeal artery
Why do tears involving dural vessels almost always stem from skull fractures in children and adults?
Because the skull is rigid and cannot deform
What is the typical outcome of an epidural hematoma if left untreated?
Death
What type of injury can cause a tear in a vessel, even in the absence of a skull fracture, in infants?
Traumatic displacement of the skull
What is the typical time frame for the manifestation of subdural hematomas?
Within the first 48 hours after injury
What is the most common location of subdural hematomas?
Over the lateral aspects of the cerebral hemispheres
What is the characteristic appearance of an acute subdural hematoma?
A collection of freshly clotted blood apposed to the contour of the brain surface
What is the typical cause of neurologic signs in subdural hematomas?
Pressure exerted on the adjacent brain
What is the characteristic progression of neurologic signs in subdural hematomas?
Slowly progressive neurologic deterioration
Study Notes
Trauma to the Central Nervous System
- Trauma to the brain and spinal cord is a significant cause of death and disability.
- The severity and site of injury affect the outcome, with injuries to the brain stem often being fatal.
Types of Head Injuries
- Injuries can be penetrating or blunt, and may cause open or closed injuries.
- Severe brain damage can occur without external signs of head injury.
Traumatic Parenchymal Injuries
- Brain injury can occur at the site of impact (coup injury) or opposite the site of impact (contrecoup injury).
- Contusions are caused by rapid tissue displacement, disruption of vascular channels, and subsequent hemorrhage, tissue injury, and edema.
- Contusions are common in regions of the brain overlying rough and irregular inner skull surfaces, such as the orbitofrontal regions and the temporal lobe tips.
Morphology of Contusions
- Contusions are wedge-shaped, with the widest aspect closest to the point of impact.
- Within a few hours of injury, blood extravasates throughout the involved tissue, across the width of the cerebral cortex, and into the white matter and subarachnoid spaces.
- Old traumatic lesions appear as depressed, retracted, yellowish brown patches involving the crests of gyri.
Traumatic Vascular Injury
- CNS trauma often directly disrupts vessel walls, leading to hemorrhage.
- Hemorrhage may be epidural, subdural, subarachnoid, or intraparenchymal, occurring alone or in combination.
Epidural Hematoma
- Epidural hematomas occur when dural vessels, especially the middle meningeal artery, are torn due to traumatic injury.
- In infants, traumatic displacement of the easily deformable skull may tear a vessel, even in the absence of a skull fracture.
- Epidural hematomas compress the brain surface and constitute a neurosurgical emergency.
Subdural Hematoma
- Rapid movement of the brain during trauma can tear the bridging veins, producing bleeding into the subdural space.
- Subdural hematomas typically become manifest within the first 48 hours after injury.
- They are most common over the lateral aspects of the cerebral hemispheres and may be bilateral.
- Neurologic signs are attributable to the pressure exerted on the adjacent brain.
Learn about the effects of trauma on the brain and spinal cord, including the severity and site of injury and their impact on outcome. Discover how different types of injuries can cause various levels of damage.
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