ECNR 4 Athens4
4 Kurs Brain Trauma
4 Kurs Brain Trauma
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Cartes-fiches
Limited use gcs?
Alkohol
drugs
Sekundäre Brain injuries
Swelling
herniation
vascular complication
prevention
Epidural hemitoma Lage
Inner table
dura mater
Epidural Hämatoms can Cross midline
Yes
Epidural haematoma
Arterial
venous
Most arterial
less venous (cerebellar)
Subdural Hämatome Cross midline?
Nö
Higighest Mortalität Rate hamatome
Akute subduralhamatoma
Traumatische subarachnoid hemorage % of traumatische Patient ?
In. 40 % of Patient
Where are cortical contusions seen? Coups comtrocoups
More contrecoups
What mesns traumatische axonal injury
1-3 lesions of Si abnormalitiy
80% are not hemoragical
more than 3 lesions - > diffuse axonal injuries
Marshall ct classificarion
Marshall classification
Diffuse injury I (no visible pathology) No visible intracranial pathology seen on CT scan
Diffuse injury II Cisterns are present with midline shift of 0-5 mm and/or lesions densities present; no high or mixed density lesion >25 cm3 may include bone fragments and foreign bodies
Diffuse injury III (swelling) Cisterns compressed or absent with midline shift of 0-5 mm; no high or mixed density lesion >25 cm3
Diffuse injury IV (shift) Midline shift >5 mm; no high or mixed density lesion >25 cm3
Evacuated mass lesion
Any lesion surgically evacuated
Non-evacuated mass lesion
High or mixed density lesion >25 cm3; not surgically evacuated
Rotterdam Score
Rotterdam CT score predictor value
basal cisterns score • normal O • compressed 1 • absent 2 •
midline shift • no shift or shift ≤ 5mm 0 • shift>5mm 1 •
Epidural Mass • present 0 • absent 1 •
Traumatic SAB or IVH absent 0 • present 1 •
sum score +1 max = 6 consistent with: motor GCS Marshall class.
How many Injurien are assotioated with Neurologie Defizit
50%
Canadian spine rule
highrisk
Low Risk
High
- Age ≥ 65 years or
- Dangerous mechanism* or
- Paresthesias in extremities
immer Bild
low- Simple accident
- sitting upride
- always ambulant
- delayed onset no midline pain
- 45 grade aktive Bewegung möglich
- kein Bild
Chance Frakturen
Horizontal pedikel und ruptured posterior Ligaments
ventral Kompression posterior ruptured
What does the stabile fractures in the spine not
Involviert nicht the middle colomne
Compressing Trauma spine
Multilevel fractures
Hangman - Stable?
Non stabile (hyperentension)
but good progrnosis
widening of spinal Canal
What is doing Iron in myelon
Chemicals make apoptosis of Healthy cells
Non hemoragical contusion of spinal Cord - prognosis
Netter than hemorrhaic
Where habe children lesions < 10 years
> 10 years
cervical spine
<10 Upper spine
laxity of Ligaments, Plastizität of vertebral Biodiesel, Ratio head Body
>10 lower spine
Low velocity Trauma in children - examination?
Plain Film ok
SCIVORA?
spinal Cord Injurie without radiographic abnormality
why?
Flexibilität of children spine - traction myelon
Type of Periode in child
perinatal period falls
(1-4 years of age) motor vehicle accidents
(7-12 years of age) abuse
Leptomenigeal Cyst?
Growing fracture
Children epidural hemitom - venous or arterial?
Mostly venous
Caput succadeneum
subgLeal hematoma
cephalhematome
Succadeneum - galea - cutis
subgaleal - periost - galea
cephal - bone - periost - sutur begrenzt
Criteria Child abuse?
when there is discrepancy between trauma history and imaging findings
if there is hemorrhage of different age
if there are unusual findings (e.g burns or bruises) - p
when retinal hemorrhage is present (shaken baby) -
if the child has evidence of poor care
Tripod Frakturen misnomer
Call is
zygomaticmaxillar complex fraktur
What to call in nasal Fraktur
Nasolacrimal duct
septum
dislokation
Le fort 1
Pterygoid fractur
nasal floor
floatimg
Le fort 3
Zygomatic Fraktur necessary
Le fort 2
Orbital medial Timm necessary
Le fort common
Pterygoid fracture
Blow out frakture
Inferior orbital rim is intakt
only floor ruptured
Trap door Frakturen ?
Fraktur offen, Weichteile gehen durch , Tür schliesst
nur fett oder Muskel herniert
Trapdoor Fraktur mit vomiting?
In 80% rectus muscle Hernien
Transversale temporal Frakturen
Sensorisch Hearing loss
facial nerve more commen
pneumolabirinth
Memory
Medial temporal l,obes - encoding Storage
prefrontsl cortex - cognitiv Control, Monitoring
thalamus, mammillary body
Medial temporal Lobe
Hippocampus
dentauts
parahippocampus
subiculum
antorhinal cortex