1. Brain Trauma Dr. Raid Jastania, FRCPC
Assistant Professor, Faculty of Medicine, Umm Alqura University
Vice Dean, Faculty of Dentistry

2. Reference and Contact Robbins Basic Pathology http://www.pathoma.com/

3. Brain Trauma Important Factors: Site of injury Severity
Energy: velocity, mass
Blunt force
Sharp force
Static head, moving head, rotational force
Associated injury

4. Intracranial Hemorrhage
Types:
Epidural (Extra dural)
Subdural
Subarachnoid
Space occupying lesion
Increased intracranial pressue
Decreased blood flow
Brain ischemia
Herniation

5. Epidural Hemorrhage Fracture of skull plates
Meningeal arteries run in grooves in the inner side of bone plates
Common injury of middle meningeal arteries at the temporal bone
Bleeding in extradural space
Displacement of brain
Rarely due to venous injury

7. Subdural Hemorrhage Rotational or shearing force
Injury of venous sinuses
Common in the very young and the very old
May be present without skull fracture
May organize

9. Subarachnoid Hemorrhage
Very common
Usually small and not fatal
Associated with brain contusion and laceration
May be fatal if large
Most common non-traumatic is due to rupture berry aneurysm in the circle of Willis

11. Brain Injury Contusions and lacerations Fracture Penetrating injury
Hemorrhage
Rotational injury
Acceleration/Deceleration injury
Shearing between different layers of brain
Laceration deep in the brain
Common at region of corpus callosum
Diffuse axonal injury

12. Brain Injury Sometimes in the absence of hemorrhage
Results in cerebral edema
Swelling of brain
Increased intracranial pressure
Herniation: tentorium cerebelli and foramen magnum
Findings: heavy brain, flat surface, hemorrhage and necrosis, compression of ventricles

13. Parenchymal Injury Changes: Wedge shape injury Edema Hemorrhage
Subarachnoid hemorrhage
Neuronal injury
Inflammation
Gliosis
Cavity
Diffuse axonal injury

14. Brain Injury Coup and contrecoup injury:
Coup injury occurs when a static head is stuck
Injury of scalp will overly injury to brain
Contrecoup injury:
Skull and brain are moving and suddenly arrested
Injury of brain is opposite to scalp or skull injury

15. Herniation Subfalcine herniation Transtentorial herniation
Tonsillar herniation

17. Subfalcine herniation
Unilateral expansion of brain
Displaces cingulate gyrus
Compress anterior cerebral artery

19. Transtentorial herniation
Medial aspect of the temporal lobe
Compression of 3rd cranial nerve, pupillary dilatation
Posterior cerebral artery, occipital lobe infarct
Compression of contralateral cerebral peduncle, ipsilateral hemiparesis
Duret hemorrhage in pons and midbrain

21. Tonsillar herniation Cerebellar tonsils through foramen magnum
Compression of respiratory centers in the medulla