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Mechanical Injuries Of Brain and Meniges. 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐...
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Transcript of Mechanical Injuries Of Brain and Meniges. 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐...
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Mechanical InjuriesMechanical Injuries
Of Of
Brain and MenigesBrain and Meniges
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11๐๐ Traumatic Traumatic LesionsLesions
22๐๐ AlterationsAlterations
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11๐๐ Traumatic LesionsTraumatic Lesions
Extracerebral lesionsExtracerebral lesions
Intracerebral lesionsIntracerebral lesions
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11๐๐ Traumatic LesionsTraumatic Lesions
Close injuryClose injury
Open injuryOpen injury
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Extracerebral LesionsExtracerebral Lesions
Epidural bleedingEpidural bleeding
Subdural bleedingSubdural bleeding
Subaracnoid bleedingSubaracnoid bleeding
IntraventricularIntraventricular bleeding bleeding
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Intracerebral LesionsIntracerebral Lesions
ContusionsContusions
Lacerations Lacerations ((or Woundsor Wounds))
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22๐๐ AlterationsAlterations
Circulatory disorderCirculatory disorder
Necroses and hemorrhagesNecroses and hemorrhages
Post-traumatic hydrocephalusPost-traumatic hydrocephalus
Secondary infectionsSecondary infections
Fat and air embolismFat and air embolism
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EpiduralEpidural
BleedingBleeding
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Epidural BleedingEpidural Bleeding
Epidural / ExtraduralEpidural / Extradural
Hemorrhage / HematomaHemorrhage / Hematoma
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CausesCauses
Skull fractureSkull fracture
Separation of dura and skull boneSeparation of dura and skull bone
Tear of a dural artery ,its branches Tear of a dural artery ,its branches and/or occasionally of a veinand/or occasionally of a vein
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Most common site: lateral convexity Most common site: lateral convexity of a cerebral hemisphereof a cerebral hemisphere
Location: it almost always at the site Location: it almost always at the site of a skull fracture of a skull fracture
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Uncommon occur in the elderlyUncommon occur in the elderly
Children: skull deformation with Children: skull deformation with separation of the dura from the bone separation of the dura from the bone without skull fracture without skull fracture
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Acute hematoma: artery bleedingAcute hematoma: artery bleeding
Delayed hematoma: venous bleeding, Delayed hematoma: venous bleeding, transient arterial spasmtransient arterial spasm
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Progression of the bleedingProgression of the bleeding
Space occupying hematomaSpace occupying hematoma
Increase intracranial pressureIncrease intracranial pressure
Confusion Confusion
Alteration of consciousnessAlteration of consciousness
Pupillary dilatation: Pupillary dilatation: on the hematoma sideon the hematoma side
Central respiratory failureCentral respiratory failure
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If venous bleeding ,or transient If venous bleeding ,or transient arterial spasm: Lucid intervalarterial spasm: Lucid interval
ConsciousnessConsciousness ( (may bemay be)) ,no signs of ,no signs of confusion: occipital poles and/or confusion: occipital poles and/or cerebellumcerebellum
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Chronic Epidural HematomaChronic Epidural Hematoma
The hematoma spontaneously shrinks and The hematoma spontaneously shrinks and becomes encapsulated by fibrous becomes encapsulated by fibrous connective tissue.connective tissue.
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SubduralSubdural
BleedingBleeding
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Subdural bleedingSubdural bleeding
Trauma Trauma
Rupture of aneurysmRupture of aneurysm
Arteriovenous malformationArteriovenous malformation
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Vein:Vein:
- Tearing of one or - Tearing of one or
- Several bridging vein- Several bridging vein
- Insignificant trauma- Insignificant trauma ( (sometimesometime)): :
abnormally located blood vessels abnormally located blood vessels
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Artery:Artery:
- particularly in branches of the middle - particularly in branches of the middle cerebral arterycerebral artery
- severe cortical contusions and bleeding - severe cortical contusions and bleeding
into subarachnoid space:into subarachnoid space: ((usuallyusually)) tears of arachnoid membrane tears of arachnoid membrane
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ArteryArtery::
- More frequently on the side opposite - More frequently on the side opposite
the impactthe impact
- - ((MayMay)) without brain contusions without brain contusions
or significant subarachnoid hemorrhage or significant subarachnoid hemorrhage
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Time of onsetTime of onset
AcuteAcute: within 12 to 24 hr. : within 12 to 24 hr.
SubacuteSubacute: from 24 hr. to 7 d.: from 24 hr. to 7 d.
ChronicChronic: more than 7 d.: more than 7 d.
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Most Location: over the convexities and the Most Location: over the convexities and the laterallateral aspects of the cerebral hemisphereaspects of the cerebral hemisphere
Often: Often: extend over the base of frontal and extend over the base of frontal and
temporal lobestemporal lobes
Occasionally: between the hemisphereOccasionally: between the hemisphere
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In skull intact: occur as often as with skull In skull intact: occur as often as with skull fracturefracture
Rare in the posterior cranial fossa , around Rare in the posterior cranial fossa , around the brain stem and cerebellumthe brain stem and cerebellum
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Chronic Subdural HematomaChronic Subdural Hematoma
Enlargement if untreatEnlargement if untreat
Isotonicity Isotonicity
Local presence of fibrinolytic enzymes: Local presence of fibrinolytic enzymes: bleeding tendencybleeding tendency
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SubaracnoidSubaracnoid
BleedingBleeding
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Subaracnoid bleedingSubaracnoid bleeding
Trauma / NontraumaTrauma / Nontrauma
Extension of intraventricular hemorrhageExtension of intraventricular hemorrhage
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Moderately severe blow to the face or Moderately severe blow to the face or foreheadforehead
Sudden ,usually severe hyperextension of Sudden ,usually severe hyperextension of the head , as from a fall onto the foreheadthe head , as from a fall onto the forehead
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Subarachnoid over the brain stem and Subarachnoid over the brain stem and basal cisterns = hydrocephalusbasal cisterns = hydrocephalus
Forgetfulness , confusion , psychotic state Forgetfulness , confusion , psychotic state
Spasticity of the lower extremitiesSpasticity of the lower extremities
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IntraventricularIntraventricular
bleedingbleeding
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IntraventricularIntraventricular bleedingbleedingMost often arterial in originMost often arterial in origin
Trauma Trauma
Non-trauma: such as rupture AVM or Non-trauma: such as rupture AVM or AneurysmsAneurysms
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IntracerebralIntracerebral
LesionsLesions
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ContusionsContusions
Lacerations Lacerations ((WoundsWounds))
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ContusionsContusions
Contusion hemorrhageContusion hemorrhage
Contusion necrosisContusion necrosis
Contusion tearContusion tear
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Intracerebral HematomaIntracerebral Hematoma
In the deeper portions of contusionsIn the deeper portions of contusions
More frequent in the frontal and /or More frequent in the frontal and /or temporal lobestemporal lobes
Location: white matter > grey matterLocation: white matter > grey matter
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Intracerebral HematomaIntracerebral Hematoma
Secondary rupture into the ventricular Secondary rupture into the ventricular system and/or the subarachnoid space system and/or the subarachnoid space usually does not occur.usually does not occur.
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LacerationsLacerations
Stab woundsStab wounds
Gunshot woundsGunshot wounds
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Gunshot woundsGunshot wounds
Shearing forces within brain tissueShearing forces within brain tissue
Expansile cavitationExpansile cavitation
Distant contusions Distant contusions ((hemorrhageshemorrhages))
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ClassificationClassification ofof
ContusionsContusionsAccording to According to
causative causative mechanismmechanism
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Depending on site and direction of impactDepending on site and direction of impact
: Coup , Intermediary coup , Contrecoup: Coup , Intermediary coup , Contrecoup
Independent of site and direction of impactIndependent of site and direction of impact
: Fracture contusion , Gliding contusion , : Fracture contusion , Gliding contusion ,
Herniation contusionHerniation contusion
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Axonal injuryAxonal injuryShearing forces due to blunt head injuriesShearing forces due to blunt head injuries
Focal , diffuse Focal , diffuse
Early ,the areas: little or no change on Early ,the areas: little or no change on gross examination of the white mattergross examination of the white matter
Older lesions: slightly gray pallor Older lesions: slightly gray pallor
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22๐๐ AlterationsAlterations
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22๐๐ AlterationsAlterations
Circulatory disorderCirculatory disorder
Necroses and hemorrhagesNecroses and hemorrhages
Post-traumatic hydrocephalusPost-traumatic hydrocephalus
Secondary infectionsSecondary infections
Fat and air embolismFat and air embolism
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Circulatory disorderCirculatory disorderSwelling of the brain: edema and cell Swelling of the brain: edema and cell necrosisnecrosis
Usually reversibleUsually reversible
Perifocal: surrounding a 1Perifocal: surrounding a 1๐๐ brain lesionbrain lesion
Generalize: a primary lesion , shockGeneralize: a primary lesion , shock
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Other rare causesOther rare causes
Obstruction of the superior sagittal sinusObstruction of the superior sagittal sinus
Traumatic thrombus or obstruction in Traumatic thrombus or obstruction in internal carotid artery internal carotid artery
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Necroses/HemorrhagesNecroses/Hemorrhages
Vascular compressionVascular compression
Shearing lesionsShearing lesions
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Necroses/HemorrhagesNecroses/HemorrhagesMany lesion are large: such as midbrain Many lesion are large: such as midbrain and ponsand pons
If rapidly progressing space occupying If rapidly progressing space occupying lesion: secondary lesion may appear lesion: secondary lesion may appear within 30 mins. After injurywithin 30 mins. After injury
Hemorrhage : sometimes small or absentHemorrhage : sometimes small or absent
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HydrocephalusHydrocephalusTraumatic or Non-traumaticTraumatic or Non-traumatic causecause
White matter loss following a shearing White matter loss following a shearing lesion and degeneration of myelinated lesion and degeneration of myelinated axonsaxons
Distension of ventricles by elevated Distension of ventricles by elevated pressure of the CSFpressure of the CSF
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Secondary infectionsSecondary infections
Meningitis Meningitis
Intracerebral abscessesIntracerebral abscesses
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MeningitisMeningitis
An infected open injury caused by a An infected open injury caused by a foreign bodyforeign body
A fracture in the wall of one of the cranial A fracture in the wall of one of the cranial sinuses associated with a tear in the dura sinuses associated with a tear in the dura and arachnoidand arachnoid
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Intracerebral abscessesIntracerebral abscesses
In the vicinity of the primary lesionIn the vicinity of the primary lesion
Complication: rupture into the underlying Complication: rupture into the underlying ventricle ventricle ((PyocephalusPyocephalus))
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Fat and air embolismFat and air embolism
Primary or Secondary lesionsPrimary or Secondary lesions
Fat embolism: fractures , stab wound at Fat embolism: fractures , stab wound at neckneck
Air embolism: stab wound at neck , a skull Air embolism: stab wound at neck , a skull fracture lacerating a paranasal dural sinusfracture lacerating a paranasal dural sinus