Understanding Head Injuries

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Questions and Answers

What type of trauma is most likely to lead to bilateral subdural haemorrhage in older individuals?

Sudden jerky movements of the head (correct)

Twisting of the neck during physical activities

Prolonged hyperextension of the neck

Compression injuries of the spinal cord

Which of the following conditions is commonly mistaken for emotional disturbances in older adults suffering from cumulative trauma effects?

Bipolar disorder

Parkinson's disease

Presenile or senile dementia (correct)

Borderline personality disorder

What is a prominent characteristic of Subarachnoid Haemorrhage (SAH)?

Gradual onset of neurological symptoms

Presence of a hematoma formation

Laceration of the spinal cord

Sudden loss of consciousness (correct)

Which spinal cord injury type is characterized by hyperextension followed by hyperflexion?

Concussion Signup and view all the answers

In which type of spinal cord injury is killing achieved by inserting a fine needle between the base of the skull and the first cervical vertebrae?

Pithing Signup and view all the answers

What characterizes a Gutter Fracture of the skull?

Thickness of the skull bone is affected. Signup and view all the answers

Which type of fracture is described as a 'crushed fracture' where the bone is broken into pieces?

Comminuted Fracture Signup and view all the answers

What indicates a fracture at the base of the skull?

Bleeding from the nose, ears, and neck. Signup and view all the answers

Which statement about the Lucid Interval is correct?

The person appears completely normal during this phase. Signup and view all the answers

What is a common cause of Extradural Haemorrhage (EDH)?

Fracture of the temporal bone. Signup and view all the answers

Subdural Haemorrhage (SDH) is characterized by:

Formation of blood cysts in the subdural space. Signup and view all the answers

Which of the following symptoms is associated with Post Concussion Syndrome?

Headache and dizziness. Signup and view all the answers

What is a distinguishing feature of a Hinge Fracture?

Fracture line running from side to side across the middle cranial fossa. Signup and view all the answers

What is the main reason why the head is often targeted in injuries?

The head is a prime target due to its vulnerability. Signup and view all the answers

What type of fracture is characterized by fragments held intact yet radiating outward?

Stellate fracture Signup and view all the answers

Which layer is NOT part of the five layers of the scalp?

Connective membrane Signup and view all the answers

What defines a depressed fracture of the skull?

Fragments driven inward corresponding in size and shape to the weapon. Signup and view all the answers

Which skull injury involves a fracture along the sutures and mainly affects children?

Diastatic fracture Signup and view all the answers

Which condition can result in contusions to the soft tissue of the orbit?

Fracture of the base of the skull Signup and view all the answers

What characterizes a linear (fissured) fracture of the skull?

Damage confined to either the outer or inner table. Signup and view all the answers

Which layer of the scalp is primarily responsible for the absorption of blunt trauma?

Loose areolar tissue Signup and view all the answers

Study Notes

Head Injuries

Head injuries are frequently the target of choice in assaults.
When victims are pushed or knocked to the ground, they often strike their heads.
The brain and its coverings are vulnerable to blunt trauma, which can be lethal if applied to other areas.
Head injuries are best understood by categorizing them in three sections:
- Scalp injuries
- Skull injuries
- Brain injuries

Scalp Injuries

The scalp is the outermost layer of the head, composed of five layers from the outside in.
- Skin
- Connective tissue (epicranial aponeurosis)
- Loose areolar tissue
- Pericranium

Skull Injuries

The skull is a diploic bone, with a thicker and stronger outer table compared to the thinner and weaker inner table
The space in between, gives the skull elasticity.
There are two types:
- Cancellous (trabecular or spongy)
- Compact (cortical) bone
Types of skull fractures include:
- Fissured fracture(linear): A fracture involving only the outer or inner table, or both.
- Stellate fracture: A radiating fracture with fragmented parts remaining intact.
- Mosaic fracture (spider's web fracture): A comminuted and depressed fracture, with tissues spreading outwards to form a web pattern.
- Depressed fracture: The fractured bone fragments are pushed inwards, and the shape mirrors the weapon that caused the trauma.
- Elevated fracture: One end of the fractured fragment is raised above the skull surface, while the other end is depressed into the cranial cavity, potentially damaging the dura mater.
- Diastrophic fracture: A fracture that occurs along the suture lines of the skull, common in children and young people.
- Gutter fracture: The thickness of the skull bones is affected, resulting in irregular depressed fractures of the inner table.
- Comminuted fracture: The bone is broken into multiple pieces.
Base of skull fractures: characterized by blood and cerebrospinal fluid (CSF) leakage from the nose, ears, or the back of the neck; associated with anterior, middle, or posterior cranial fossa fractures.
Ring fracture: A fracture encircling the foramen magnum, usually from a fall landing on the crown of the head.
Hinge fracture: A fracture that runs across the floor of the middle cranial fossa and through the pituitary fossa (more common in motorcyclists).

Brain Injuries & Intracranial Haemorrhage

Cerebral concussion: A temporary disruption of neuronal activity without demonstrable brain lesions.
Clinically, a concussion presents as:
- loss of consciousness
- flaccidity of muscles, and,
- recovery of consciousness, with the possibility of re-losing consciousness.
Post-concussion syndrome: Neurological symptoms following concussion include headache, dizziness, nervousness, and, in some cases, epilepsy.
Lucid interval: A recovery period between unconsciousness episodes, when the patient appears perfectly normal.
Extra-dural haemorrhage (EDH): Bleeding outside the dura mater, often due to a fractured temporal bone and middle meningeal artery rupture.
Collected blood leads to intracranial pressure (ICP) increases and brain displacement, resulting in loss of consciousness and coma.
Subdural haemorrhage(SDH): Bleeding in the subdural space (no mesothelial lining). This results in blood cysts and is commonly seen in children and the elderly.
Causes of SDH:
- Glidng movements between the dura and arachnoid mater
- Bruising and laceration of the brain
- Minor trauma.
Subarachnoid haemorrhage(SAH): bleeding in the subarachnoid space, caused by trauma, and certain medical conditions
- Causes include:
  - All traumatic causes
  - Prolonged hyperextension of the neck
  - Diseases (like atherosclerosis, hypertension, or leukemia)
  - Berry aneurysms of the basilar artery
Findings in serious brain injuries include:
- Ipsilateral dilated pupils
- Contralateral paresis (weakness on the opposite side of the brain from the injury)
- Lucid interval
- Automatic movements
- Possible confusion mistaken for intoxication, leading to arrest.

Spinal Cord Injuries

Four types of spinal injuries:
- Concussion: (Whiplash) hyperextension followed by hyper flexion, causing dislocation at C4-C6 with haemorrhage in spinal cord substance, resulting in quadriplegia.
- Compression: Spinal cord compression in fracture-dislocation (in Pott's disease).
- Pithing: Killing by stabbing a fine needle into the nape of the neck between the base of the skull and the first cervical vertebrae.
- Lacerations : Twisting of the neck may produce lacerations without external injuries (like infanticide or wrestling)

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Description

This quiz delves into the categorization and details of head injuries, including scalp, skull, and brain injuries. It explores the anatomy of the head and the implications of different types of traumas. Get ready to test your knowledge on this critical topic in medical science!