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Mechanical Injuries Of Brain and Meniges. 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐ Alterations 2 ๐ Alterations.

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Presentation on theme: "Mechanical Injuries Of Brain and Meniges. 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐ Alterations 2 ๐ Alterations."— Presentation transcript:

1 Mechanical Injuries Of Brain and Meniges

2 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐ Alterations 2 ๐ Alterations

3 1 ๐ Traumatic Lesions Extracerebral lesions Extracerebral lesions Intracerebral lesions Intracerebral lesions

4 1 ๐ Traumatic Lesions Close injury Close injury Open injury Open injury

5 Extracerebral Lesions Epidural bleeding Epidural bleeding Subdural bleeding Subdural bleeding Subaracnoid bleeding Subaracnoid bleeding Intraventricular bleeding Intraventricular bleeding

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7 Intracerebral Lesions Contusions Contusions Lacerations (or Wounds) Lacerations (or Wounds)

8 2 ๐ Alterations Circulatory disorder Circulatory disorder Necroses and hemorrhages Necroses and hemorrhages Post-traumatic hydrocephalus Post-traumatic hydrocephalus Secondary infections Secondary infections Fat and air embolism Fat and air embolism

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10 Epidural Bleeding

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12 Epidural Bleeding Epidural / Extradural Epidural / Extradural Hemorrhage / Hematoma Hemorrhage / Hematoma

13 Causes Skull fracture Skull fracture Separation of dura and skull bone Separation of dura and skull bone Tear of a dural artery,its branches Tear of a dural artery,its branches and/or occasionally of a vein and/or occasionally of a vein

14 Most common site: lateral convexity of a cerebral hemisphere Location: it almost always at the site of a skull fracture

15 Uncommon occur in the elderly Children: skull deformation with separation of the dura from the bone without skull fracture

16 Acute hematoma: artery bleeding Delayed hematoma: venous bleeding, transient arterial spasm

17 Progression of the bleeding Space occupying hematoma Space occupying hematoma Increase intracranial pressure Increase intracranial pressure Confusion Confusion Alteration of consciousness Alteration of consciousness Pupillary dilatation: on the hematoma side Pupillary dilatation: on the hematoma side Central respiratory failure Central respiratory failure

18 If venous bleeding,or transient arterial spasm: Lucid interval Consciousness (may be),no signs of confusion: occipital poles and/or cerebellum

19 Chronic Epidural Hematoma The hematoma spontaneously shrinks and becomes encapsulated by fibrous connective tissue.

20 Subdural Bleeding

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22 Subdural bleeding Trauma Trauma Rupture of aneurysm Rupture of aneurysm Arteriovenous malformation Arteriovenous malformation

23 Vein: Vein: - Tearing of one or - Tearing of one or - Several bridging vein - Several bridging vein - Insignificant trauma (sometime): - Insignificant trauma (sometime): abnormally located blood vessels abnormally located blood vessels

24 Artery: Artery: - particularly in branches of the middle - particularly in branches of the middle cerebral artery cerebral artery - severe cortical contusions and bleeding - severe cortical contusions and bleeding into subarachnoid space: into subarachnoid space: (usually) tears of arachnoid membrane (usually) tears of arachnoid membrane

25 Artery : Artery : - More frequently on the side opposite - More frequently on the side opposite the impact the impact - (May) without brain contusions - (May) without brain contusions or significant subarachnoid hemorrhage or significant subarachnoid hemorrhage

26 Time of onset Acute: within 12 to 24 hr. Subacute: from 24 hr. to 7 d. Subacute: from 24 hr. to 7 d. Chronic: more than 7 d. Chronic: more than 7 d.

27 Most Location: over the convexities and the lateral aspects of the cerebral hemisphere Often: extend over the base of frontal and temporal lobes temporal lobes Occasionally: between the hemisphere

28 In skull intact: occur as often as with skull fracture Rare in the posterior cranial fossa, around the brain stem and cerebellum

29 Chronic Subdural Hematoma Enlargement if untreat Isotonicity Local presence of fibrinolytic enzymes: bleeding tendency

30 Subaracnoid Bleeding

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32 Subaracnoid bleeding Trauma / Nontrauma Extension of intraventricular hemorrhage

33 Moderately severe blow to the face or forehead Sudden,usually severe hyperextension of the head, as from a fall onto the forehead

34 Subarachnoid over the brain stem and basal cisterns = hydrocephalus Forgetfulness, confusion, psychotic state Spasticity of the lower extremities

35 Intraventricular bleeding

36 Intraventricular bleeding Most often arterial in origin Trauma Non-trauma: such as rupture AVM or Aneurysms

37 Intracerebral Lesions

38 Contusions Lacerations (Wounds)

39 Contusions Contusion hemorrhage Contusion hemorrhage Contusion necrosis Contusion necrosis Contusion tear Contusion tear

40 Intracerebral Hematoma In the deeper portions of contusions More frequent in the frontal and /or temporal lobes Location: white matter > grey matter

41 Intracerebral Hematoma Secondary rupture into the ventricular system and/or the subarachnoid space usually does not occur.

42 Lacerations Stab wounds Stab wounds Gunshot wounds Gunshot wounds

43 Gunshot wounds Shearing forces within brain tissue Expansile cavitation Distant contusions (hemorrhages)

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46 Classification of Contusions According to causative mechanism

47 Depending on site and direction of impact : Coup, Intermediary coup, Contrecoup : Coup, Intermediary coup, Contrecoup Independent of site and direction of impact : Fracture contusion, Gliding contusion, : Fracture contusion, Gliding contusion, Herniation contusion Herniation contusion

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52 Axonal injury Shearing forces due to blunt head injuries Focal, diffuse Early,the areas: little or no change on gross examination of the white matter Older lesions: slightly gray pallor

53 2 ๐ Alterations

54 Circulatory disorder Circulatory disorder Necroses and hemorrhages Necroses and hemorrhages Post-traumatic hydrocephalus Post-traumatic hydrocephalus Secondary infections Secondary infections Fat and air embolism Fat and air embolism

55 Circulatory disorder Swelling of the brain: edema and cell necrosis Usually reversible Perifocal: surrounding a 1 ๐ brain lesion Generalize: a primary lesion, shock

56 Other rare causes Obstruction of the superior sagittal sinus Traumatic thrombus or obstruction in internal carotid artery

57 Necroses/Hemorrhages Vascular compression Vascular compression Shearing lesions Shearing lesions

58 Necroses/Hemorrhages Many lesion are large: such as midbrain and pons If rapidly progressing space occupying lesion: secondary lesion may appear within 30 mins. After injury Hemorrhage : sometimes small or absent

59 Hydrocephalus Traumatic or Non-traumatic cause White matter loss following a shearing lesion and degeneration of myelinated axons Distension of ventricles by elevated pressure of the CSF

60 Secondary infections Meningitis Meningitis Intracerebral abscesses Intracerebral abscesses

61 Meningitis An infected open injury caused by a foreign body A fracture in the wall of one of the cranial sinuses associated with a tear in the dura and arachnoid

62 Intracerebral abscesses In the vicinity of the primary lesion Complication: rupture into the underlying ventricle (Pyocephalus)

63 Fat and air embolism Primary or Secondary lesions Fat embolism: fractures, stab wound at neck Air embolism: stab wound at neck, a skull fracture lacerating a paranasal dural sinus


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