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Block 4 PATH Exam -- CNS Trauma


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What age groups are often affected by falls?
< 15 y.o.
> 65 y.o
Contusions are damage to what?
Damage to the brain surface
Where in the skull do linear fractures occur?
In the cranial vault, between bony ridges of the skull
And/or across the base of the skull
What is a contrecoup fracture?
Fracture on the opposite side of the skull from the impact
Epidural hematomas involve damage to what artery?
Middle meningeal
What are the most common locations of contusions?
Inferior front "tips" of frontal and temporal lobes
Inferior/lateral surface of the temporal lobes
Occipital pole

Progressively less common, "further up and down" brain
(pic in slides)
What is a depressed fracture?
Fracture of the skull, in which a fragment is depressed (pushed in)

Often entails a scalp laceration
What is a coup lesion?

What is a contrecoup lesion?
Contusion AT SITE of impact

Contusion at the OPPOSITE SIDE from impact
What is a hematoma?
A collection of blood OUTSIDE of a blood vessel
What area do epidural hematomas most commonly occur in?
Parieto-temporal region
Subdural hematomas most commonly involve damage to what?
Bridging veins
How do epidural and subdural hematomas compare?
(with regards to time frame)
Epidural -- acute

Subdural -- acute/subacute/chronic (LESS acute than epidural)
What area do subdural hematomas most commonly occur in?
Over the cerebral convexities
Where do intraparenchymal hematomas commonly occur (3)?
Cortex (assoc. w/ contusions)
Frontal & temporal lobes
Intraventricular extensions
Subarachnoid hemorrhages most commonly involve damage to what?
Cortico-meningeal arteries
What is the time frame for intraparenchymal hematomas to present?
Commonly delayed
> 24 hours following trauma
What structures are particularly susceptible to diffuse axonal injury?
Hemispheric white matter
Corpus callosum
Internal capsule
White matter tracts of brain stem
In diffuse vascular injury, what happens in the ACUTE phase?

Small petechial hemorrhages

Same locations as diffuse axonal injury
In Diffuse Vascular Injury, what happens in the CHRONIC phase?
Glial scarring and development of cystic lesions
What is diffuse axonal injury?
Acute stretching of axons (long tracts)
What is diffuse vascular injury?
Stretching of microvessels
What is a penetrating injury?

A perforating injury?
Something enters the skull, injuring it, but does NOT exit

Something enters and exits the skull
Comparison of entrance and exit wound if:

Contact from CLOSE to the head
Contact from FAR from the head
Close -- Entrance > Exit

Far -- Exit > Entrance
Difference in timing, etc. of injury by low vs. high velocity bullets
LOW vel. -- compression and herniation slightly delayed
(due to buildup of edema & hemorrhage)

HIGH vel. -- immediate compression and herniation
(due to shockwave of bullet passing through)
Demographic most commonly incurring spinal cord injuries
50% of pts. are < 25 y.o.
80% are male
Of those who die from spinal cord injury, when do most die?
50% die within the 1st month
(NOTE: only 10% of SC injury pts. die, most survive)
What happens within minutes to hours after traumatic neuronal damage (4)?
Release of serum proteins and proteinases
Neuronal & glial ischemia (due to vascular damage)
Free radical generation
Lipid hydrolysis
What happens within hours to days after traumatic neuronal damage (2)?
Excitotoxic cell death
Progressive inflammatory reaction
What happens within days to months after traumatic neuronal damage (2)?
Astrocytic activation & chronic glial scarring

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