TRAUMATIC VASCULAR DISEASE

Mechanism

1. Vascular injury( disruptions of vessel wall) due to CNS trauma

2. Hemorrhage in different anatomical site

Site of hemorrhage

Depends on the position of ruptured vessels

1. Epidural compartment

2. Subdural compartment

3. Subarachnoid compartment

4. Intraparenchymal compartment

5. Sometimes in combination

Nature of traumatic cerebral injury

• produce focal and diffuse lesions

Causes and types of injuries

1. Skull fractures

• depressed fractures

• Basal fractures

2. Parenchyma fracture

• coup contusion

• countrecoup contusion

• Intracerebral hematoma

3. Vascular injury

• Epidural hematoma → middle meningeal artery tear

• Subdural hematoma→ bridging vein rupture

• Traumatic subarachnoid hemorrhage

4. Diffuse injury

• diffuse axonal injury

• Lead to coma

• Lead to vegetative state

Clinical features

• sudden focal neurological deficit

• Headache

• Vomiting

• Altered conciousness

Depend on the size or site

• hemiplegia

• Aphasia

• Coma

Morphology of traumatic hemorrhage

General features

• hematoma within brain parenchyma

Acute Subdural hematoma

• fresh blood clot along brain surface

• No extension to sulci depths

• Clear subarachnoid space

• Cerebral oedema

• Mass effect lead to midline shift

• Healing sequence

→lysis of clot ( 1 week)

→ growth of fibroblasts into hematoma (2weeks)

→ early development of hyalinized connective tissue( 1-3 months)

final results

• organized hematoma firmly attached to inner surface of dura

• Venous bleeding is self limited