2. Consequences of CNS Trauma Anatomic location Limited capacity for functional repair Silent Severely Disabling Fatal
3. Physical Forces SKULL FRACTURES PARENCHYMAL INJURY VASCULAR INJURY May coexist Shape of object causing the trauma Force of impact Head is in motion at the time of injury
5. SKULL FRACTURES Displaced Skull Fracture varying thickness of the skull pattern of falls BASAL SKULL FRACTURE CSF leak, hematomas Diastatic Fracture – follows cranial sutures
6. PARENCHYMAL INJURIES Concussion Altered consciousness – transient neurologic dysfunction Recovery is complete Unknown pathogenesis, dysregulation of the reticular activating system
7. PARENCHYMAL INJURIES Direct Parenchymal Injury CONTUSION and LACERATION BRUISING or TEARING rapid tissue displacement, disruption of vascular channels, subsequent hemorrhage, tissue injury, and edema Fracture Contussion Coup Injury Contre Coup Injury
8. PARENCHYMAL INJURIES Diffuse Axonal Injury deep white matter regions: corpus callosum, paraventricular, and hippocampal areas, cerebral peduncles, brachium conjunctivum, superior colliculi, and deep reticular formation Axonal swelling and focal hemorrhages
9. TRAUMATIC VASCULAR INJURY EPIDURAL – arterial, in between skull and dura SUBDURAL – venous, in between dura and leptomeninges SUBARACHNOID – in the CSF flow INTRAPARENCHYMAL – within the brain substance
10. SEQUELAE OF BRAIN TRAUMA broad range, months or years post traumatic hydrocephalus post traumatic dementia punch-drunk syndrome (dementia pugilistica) findings: hydrocephalus, thinning of the corpus callosum, diffuse axonal injury, neurofibrillary tangles, diffuse amyloid β others: epilepsy, tumors, infections, psychiatric disorders
11. SPINAL CORD TRAUMA Within bony vertebral canal displacement of the vertebral column level of cord injury determines the extent of neurologic manifestations thoracic: paraplegia cervical: quadriplegia above C4: respiratory paralysis Segmental damage to the ascending and descending white matter tracts
