Mechanisms of Injury, TBI, Cerebrovacular Disease

Head Injury

Any damage to the head from trauma (brain may NOT be affected)

Traumatic Brain Injury

Brain trauma from external force that interferes with daily life & requires medical treatment

Differentiate primary vs secondary brain injuries

Primary: Happens right away from direct hit to head/brain

Secondary: Happens later (hours–days) from ↓ oxygen & nutrients

What are the 3 components of the cranial vault?

Brain, blood, cerebrospinal fluid

Monro-Kellie Hypothesis?

Skull = closed system with 3 parts: brain, blood, CSF

If one ↑ → another must ↓

If not → ↑ ICP → brain herniation 🚨

What are key signs of increased ICP / brain injury to monitor (especially first 24 hrs)?

• ↓ LOC (drowsy, hard to arouse)

• N/V (projectile vomiting 🚨)

• Seizures

• Neck stiffness

• Blurred vision / unequal pupils (⚠ herniation sign)

• CSF leak (nose/ears)

Abrasion

Scrape (like carpet burn)

Contusion

Bruise

Laceration

Cut

Subgaleal Hematoma

Collection of blood on top of the skull underneath the skin

Avulsion

Scalp torn off; life threatening

Skull Fracture

Break in the skull from trauma; may occur with or w/o damage to brain

3 Types of Skull Fractures

Linear = simple break

Comminuted = multiple pieces

Depressed = pushed inward

What are locations of skull fractures?

Frontal, Temporal, Basal

What is an open skull fracture?

Scalp cut or dura torn

Differentiate open vs closed skull fracture.

Open: Scalp cut or dura torn

Closed: Dura intact

Persistent, localized head pain means what?

Skull fracture

Battle Sign

Bruising behind the ear = RED FLAG of abuse

What suggests a basal skull fracture?

CSF leaking from nose or ears (r/f meningeal infection)

How are skull fractures managed?

Non-depressed → no surgery

Depressed → surgery within 24 hrs (lift bone, clean area)

Brain contusion?

Brain bruise from blunt force or rapid movement (often frontal/temporal)

Epidural hematoma?

Arterial bleed between skull & dura (middle meningeal artery)

Epidural hematoma symptoms?

Brief LOC → lucid interval → rapid decline (confusion, coma)

Subdural hematoma?

Collection of blood between dura and brain; characterized by low pressure bleeding

Intracerebral hemorrhage?

Bleeding inside the brain

Key sign of intracerebral hemorrhage?

Sudden neurological deficit

Subarachnoid hemorrhage?

Bleeding in the subarachnoid space

Concussion?

Temporary loss of brain function without structural damage (from blow or rapid movement)

Confusion symptoms?

Neurological dysfunction, vision trouble

Concussion treatment?

Rest 6-8 wks, r/f second impact