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CNS Trauma


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Loss of the sense of smell.
Anosmic (Bad sign after a head injury b/c means head was shaken very badly)
Focal areas of necrosis in gyral crests, usually with overlying SAH.
Lesions found directly underneath the site of trauma.
coup lesions
Lesions found diametrically opposed to the traumatic impact.
contrecoup lesions
What is a common complaint of patient's with a concussion?
lack of concentration
What is the first thing performed if head injury is suspected?
Glascow Coma Scale
Brain starts to die after ___ minutes w/o oxygen.
Epidural hematomas result from a tear in which vessel?
Middle meningeal artery
Epidural is often associated with a _____.
lucid interval in which the patient is alert, but w/ headache and confusion "still drunk"
Subdural hemorrhages arise from tears in what?
Bridging veins, occurs slowly
SD hematomas are more common in what populations?
elderly due to cerebral atrophy and susceptibility to falls, Alzheimer patients, and children (due to activity)
SD hematomas can organize and form _____ tissue.
Cerebral edema is characterize by?
blunting of gyra and narrowing of sulci
Name the type of herniation: symmetrical swelling of both hemispheres. Swelling forces brainstem downward closing off 3rd ventricle leading to hydrecephalus.
Central herniations are common in _____ events.
global (e.g. anoxia)
Name the herniation: Cingulate gyrus is pushed underneath the the falx cerebri.
Sub-falcine herniations are seen in ______ lesions.
Sub-falcine herniations can damage what?
corpus callosum
Name the herniation: Uncus is pushed downward into posterior fossa, compressing the brain stem.
What are some complications of an uncal herniation?
alterations of consciousness, CN III palsies, hemiparesis
Uncal herniations can lead to compression of which artery?
Midline hemorrhages seen in a uncal herniation.
Duret hemorrhages
Names the herniation: increase in intercranial pressure pushes tonils of cerbellum through the foramen magnum.
Name the injury: Blunt trauma to the head causes stretching of fibers, breaking them. Numerous broken, clubbed axons throughout white matter. No gross evidence of damage.
Diffuse Axonal Injury
What type of embolism often follows a fracture of a long bone?
fat embolism
In a GSW which matters more the size of the bullet or the speed?
Speed, E = 1/2MV^2
What is the major blood supply to the spinal cord?
anterior spinal artery
Superficial gastric ulcers that can follow many types of systemic stress including head trauma.
Cushing's ulcers
A syndrome of chronic brain damage.
dementia pugilistica or "punch drunk syndrome"
What are the three phases of a spinal cord injury?
acute phase, latent period, and late phase
Complex sequence of events following axonal severage.
Wallerian degeneration
First step in distal axonal degeneration.
Develops irregular swelling (varicosities) and then fragments
What changes occur in the cell body when an axon is severed?
Nissl substance disappears, cell body swells, and nucleus is pushed to the periphery
Series of events that occur in cell body after axon is severed.
Central chromalysis
Subarachnoid hemorrhages are usually due to rupture of what vessels?
small cortical vessels
Transient neurological deficit w/ no anatomic correlate.
Major TBI is defined by:
GCS less than 8 with a positive CT
ABCDE's of initial assesment of TBI
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Evaluate
Three components of Glasgow Coma Scale
Motor, Eye Opening, Verbal
Raccoon eyes are often seen with this fracture
frontal sinus
Rupture of a blood vessel and then a fibrous reaction around vessel to repair defect.
ASIA classification of a SCI
A - complete
B - incomplete sensory
C - incomplete motor less than 3
D - incomplete motor greater than 3
E - normal
3 Column model of stability
Anterior - Anterior half of vertebral body and ALL
Middle - posterior half of vertebral body and PLL
Posterior - pedicles, facets, laminae w/ ligamentum flavum, interspinous ligament, facet capsules
Where are the most vulnerable areas of spine stablity?
C5-C6 and L1
Cervical Flexion Injury
compression w/ flexion, teardrop fracture, severe SCI, instability in 3 columns
Cervical Extension Injury
posterior element fractures, often w/o fracture esp. in elderly, associated w/ "central cord syndrome"
Central hemorrhage may damage the medial portion of the lateral corticospinal tract resulting in paralysis of upper limbs w/ lower limbs intact.
Central Cord Syndrome
Cervical Distraction Injury
ligamentous injury, posterior element fracture, disc disruption, associate w/ severe SCI
Thoracolumbar Burst Fracture
Instability at thoracolumbar junction, injury to conus medullaris and cauda equina
Late sequela of SCI. Associated w/ ascending weakness, loss of pain/temperature, scoliosis.
Traumatic Syringomyelia

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