CNS Trauma

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CNS Trauma

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

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