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Occurs in :
- traffic accident
- hairs entangled in machinery
Avulsion of scalp
INJURIES TO FACE
EARS
A blow may produce -
1.Rupture of the tympanum
2.Deafness
3.Labyrinth may injured
FACIAL BONES
A blow often fractures the nasal bone and also ethmoid
bone with radiating fractures into supraorbital plates, if
the force is severe.
A blow may fracture maxilla and malar bone.
Pulping of face may result from striking with a heavy stone.
The mandible is fractured by a blow from a fist, stick or by
fall from height.
A heavy blow on the jaws drives the condyles against the
base of skull producing a fissured fracture.
TEETH
A fall or a blow with a blunt weapon may cause fracture or
dislocation of teeth, with contusion or laceration on lips
or gums and bleeding from the sockets.
SKULL
The outer table is twice the thickness of
inner.
In young males,the thickness of -
Frontal and parietal bone = 6 to 10 mm
Occipital bone =15 mm.
Temporal bone = 4 mm.
Skull is thicker in midfrontal, midoccipital,
parieto-sphenoid and parieto-petrous
buttresses.
Force required to fracture a cadaver skull –
2.Transverse
Results from an impact on either side of head or side
to side compression
3.Ring fracture
Anterior fossa fracture are due to
direct impact on chin.
3. Leptomeningitis
4. Cranial pneumatocele
5.Middle fossa fracture through basioccipit or
sphenoid → bleeding from mouth
3. Suicide - by insane
AGE OF SKULL INJURY
Healing occurs without the formation of visible
callus, as periosteal blood vessels are damaged
1st week-
- Edges of fissured fracture stick together
14 days-
- Edges are slightly eroded
- Inner surface of the skull shows pitting or deposition
of salt
3-5 week
- Edges become slightly smooth and bands of
osseous tissue run across the fissure.
INJURIES OF BRAIN & MENINGES
1. Open injuries - if dura is lacerated,
e.g. by bullet or fragment of bone
2. By Distortion of skull -
- a localised segment undergoes deformation
→ shear strain in the brain tissue → contusion in
surface layer
- fractured bone may penetrate the dura → laceration.
3 Acceleration / Deceleration injuries:
Mild concussion
- consciousness is not lost
- no confusion or disorientation (± amnesia)
Severe concussion
- amnesia and loss of consciousness
Cerebral concussion may be produced by
2. Indirect violence
a) fall upon the feet or buttocks
b) an unexpected fall on the ground in
traffic or industrial accidents
During established concussion:-
a) muscles - flaccid
b) pupils - dilated and unreacting
c) pulse - weak and slow
d) respiration - shallow
connection.
DIFFUSE AXONAL INJURY
2.Oedema
Contracted in coma,
dilate on external stimuli and
Pupils Contracted or unequal
contract again,
reaction to light -sluggish
Retrograde amnesia
Memory Confused
unrelieved by time.
Uncooperative, abusive,
Behavior unresponsive, insolent, Cooperative quiet.
talkative
Contusion of brain
Localised deformation of skull → shear strain
develops in the brain tissue → a zone of contusion
in the surface layer
At the crest
3.Gliding contusion
4.Herniation contusion
CEREBRAL LACERATION
There is loss of continuity of the substance of brain.
Surface lacerations are accompained by ruptures of
pia matter and subarachnoid haemorrhage
When parenchyma is completly disorganised it is
termed pulpefaction
Usually seen underneath skull fractures
In depressed fractures the bone fragments tear the
brain surface
All penetrating injury produce laceration of brain.
Blunt trauma, without fracture skull lacerates the
corpus callosum or septum pallucidum in younger
individual
In severe hyperextention of head -
At pontomedullary junction, there may be -
→ laceration in the pyramid
or
→ avulsion of the brain stem
Usually associated with fractures of the base of the
skull and upper cervical vertebrae.
Slit-like or irregularily shaped
Contain very little blood
Adhesions may develop between the brain and dura
mater due to healing of surface laceration → causing
Secondary epilepsy
Healing of deep laceration involving ventricles may
produce large glial cyst, filled with CSF (Traumatic
Porencephalic Cyst)
LACERATION
CEREBRAL OEDEMA
It occurs due to localised or diffuse
accumulation of water and sodium → increases
the volume of the brain
It is caused due to : -
- ↑ intravascular pressure
- ↑ permeability of the cerebral vessels
- ↓ plasma colloidal osmotic pressure
Within 20 minutes
Head injury ---------→ Massive cerebral swelling
Types : 1. Supratentorial
2. Infratentorial
Supratentorial
Squeezing of Uncus or Temporal Lobe (inner margin)
through hiatus
↓
Squeezing of Mid brain (A-P lenghthening)
↓
Streching of Paramedian & Nigral blood vessels
↓
Rupture
↓
Hemorrhage in Midline & Substantia Nigra (Fatal)
Infratentorial
Rise in pressure
↓
Forces cerebellar lobe and tonsils
through foramen magnum
↓
Compresses medulla oblongata
↓
Respiratory failure
P. M. Findings
1. Uncal grooving
Flattening of gyri
Narrowing of sulci
Toxic agents
BRAIN STEM
May be injured by -
1.Streching of peduncles
1.Extradural Haemorrhage
2.Subdural Haemorrhage
3.Subarachnoid Haemorrhage
4.Intracerebral Haemorrhage
EXTRADURAL HAEMORRHAGE
(EDH)
Exclusively due to trauma
Occurs due to :
- fall from height
- hit by a moving object
- after a minor accident
Coup
- Contre-coup in gross deformity
- B/L in B/L trauma
Temporary unconciousness
C/L Hemiparesis
I/L Dilation of Pupil, not reacting to light (Anisocoria)
PM Findings-
- Fisssured fracture
- Break in vessels
CHRONIC EDH
Rare
± Fracture
Commonly seen in older children and
young adults
Symptoms are noted 2 to 3 days after
injury
Sudden death may occurs after several
days
SUBDURAL HEMORRHAGE
(SDH)
Arachnoid is -
- thin, vascular meshwork and is intimately applied to
the inner surface of the dura
- attached to the dura by venous sinuses and
arachnoid granulations
opposite hemisphere
U/L or B/L
1.Acute
2.Subacute
3.Chronic
ACUTE SDH
D/t - rupture of - large bridging veins
- cortical artery
- laceration
Spreads freely in subdural space
± Brain injury
± Neurologic symptoms
Gradually encapsulated
AUTOPSY
In mild forms - splashes of haemorrhage over the
areas of contusion
ARTEFACT
Produced at autopsy d/t -
a) damage to cerebral vein and the arachnoid
b) decomposition with:
- lysis of blood cells
- loss of vascular integrity
- leakage of blood in SA space
INTRACEREBRAL HAEMORRHAGE
(ICH)
5. Laceration of brain
7. Intraventicular haemorrhage
INTRAVENTRICULAR
HAEMORRHAGE
D/t head striking firm object
Bleeds from - choroid plexuses
- veins of septum pelucidum
- rupture of an AV fistula
Also d/t extension of non traumatic ICH
Death - rapid or delayed for several days
INTRA CEREBRAL HEMORRHAGE
INTRACEREBRAL HEMORRHAGE
NON TRAUMATIC ICH
In hypertensive cerebrovascular disease
With physical exercise or excitement
D/t rupture of lenticulostriate artery
Spontaneous hemorrhage in basal ganglia,
thalamus, external capsule, pons or
cerebellum
Common in middle aged and elderly
Difference B/W Post-traumatic ICH & Apoplexy
Po st-traumatic
Trait Apoplexy
haemorrhage
Hypertention,
1. Cause Head injury
atherosclerosis, aneurysm
2. Age Young individuals Adults past middle age
Distinct interval (few min
3. Onset to several hrs) b/w Sudden
violence and symptoms
4. Position of head In motion Any position
White matter of temporo-
5. Region Ganglionic region
occipital or frontal region
6. Contrecoup haemorrhage May be present Not present
May be seen, may become
7. Concussion conscious before clinical Not present
effect appear
8. Coma Spontaneous variation Deep unconciousness
Questions
1. Contre coup injuries are seen in :
A) Heart
B) Brain.
C) Lungs
D) Uterus
2. Depressed fracture of skull is produced
by:
A) A light weight blunt object
B) A heavy weight blunt object with small
striking surface.
C) A heavy weight blunt object with big
striking surface
D) Fall on the road
3. Sutural surface of skull is also known
as :
A) Diastatic fracture.
B) Fissured fracture
C) Depressed fracture
D) Comminuted fracture
4. Spider web fracture of skull is other
name for:
A) Diastatic fracture
B) Fissured fracture
C) Depressed fracture
D) Comminuted fracture.
5. Gutter fracture of skull is due to:
A) Sharp pointed weapon
B) Fire arm injury.
C) Blunt weapon
D) Heavy cutting weapon
6. Contre coup injuries of the brain are seen
at:
A) Adjacent to site of impact
B) Away from the site of impact
C) Anywhere in the brain
D) Just opposite to the site of impact.
7. Punch drunk syndrome is commonly
seen in :
A) Tailors
B) Cobblers
C) Boxers
D) Cricket players
8. Ring fracture is a type of fracture of :
A) Mandible
B) Skull.
C) Humerus
D) Femur
9. Fracture of the base of the skull may
result from:
A) Fall from feet
B) Blow over chin
C) Blow over vertex
D) All of the above.
10. Contre coup injuries are usually
seen, when head is :
A) Not supported
B) Supported.
C) Covered with a heavy object
D) Moving at a great speed
11. Bevelling of inner table of the skull
bone is suggestive of :
A) Burr hole
B) Penetrating wound
C) Fire arm entry wound.
D) Perforating wound
12. Commonest type of intracranial
haemorrhage is :
A) Subarachnoid .
B) Subdural
C) Intracerebral
D) Extradural
13.Rupture of berry aneurysm leads to :
A) Subarachnoid haemorrhage.
B) Subdural haemorrhage
C) Extradural haemorrhage
D) All of the above
14. Ring fracture of skull is produced by :
A) A blow on the front of head with blunt
object
B) A blow on the side of head with blunt
object
C) Fall from height landing on buttocks.
D) A hit with a small bullet over the head
15. CHF ottorrhea is caused by:
A) Fracture of cribriform plate
B) Fracture of parietal bone
C) Fracture of petrous temporal bone.
D) Fracture of tympanic membrane
16. Most common site for fracture
mandible :
A) Condyle.
B) Angle
C) Body
D) Symphysis
17. Lucid interval is classically seen in:
A) Intracerebral hematoma
B) Acute subdural hematoma
C) Chronic subdural hematoma
D) Extradural hematoma.
18.True about CSF rhinorrhoea:
A) Commonly occurs due to break in
cribriform plate.
B) Contains less amount of proteins
C) Decreased glucose content confirms
diagnosis
D) Immediate surgery is required
19. Characteristic of anterior cranial
fossa fracture :
A) Black eye.
B) Pupillary dilatation
C) CSF otorrhea
D) Hemotympanum
20.Orbital blow out fracture involves :
A) Lateral wall and floor of orbit
B) Medial wall and floor of orbit
C) Lateral wall and roof of orbit
D) Medial wall and roof of orbit