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TRAUMATIC VASCULAR INJURY. Epidural Hematoma: Arterial bleedingFrom skull fracture related Middle meningeal artery tearBlood collects between the dura
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1. Central Nervous System3. Traumatic Vascular Injuries
2. TRAUMATIC VASCULAR INJURY Epidural Hematoma:
Arterial bleeding
From skull fracture related Middle meningeal artery tear
Blood collects between the dura & skull bone (outside dura)
Compressing the underlying brain – eventually results in uncal herniation
NOT self limiting
Often do not lose consciousness
Takes a while for patient to be symptomatic (2-8 hrs)
3. Subdural Hematoma:
Venous bleeding from torn veins bridging between the brain & the dural sinuses.
Blood collects in between the dura & the arachnoid.
Venous bleeding is self-limited acutely
May undergo organization – granulation type tissue
May rebleed to point of brain herniation
May occur with only minor trauma with a small atrophic brain
Elderly, alcoholics & dementias
Traumatic Subarachnoid Hemorrhage:
Traumatic rupture of small vessels in the subarachnoid space.
Traumatic Intraparenchymal Hemorrhage:
Traumatic rupture of small vessels within the brain parenchyma.
Penetrating injury to brain (like gunshot wound to head)
4. Subarachnoid Hemorrhage MCC: ruptured berry aneurysm (defective media). Anterior communicating Occur around circle of Willis Congenital absence of media – weakening of vessel wall which balloons out and causes an aneurysm LCC: atherosclerotic & Mycotic aneurysms (usually bacterial infection of vessel wall) Risk of rupture increases with the size of aneurysm Berry aneurysm on the right middle artery – can have mass effects >10 mm = 50% risk of rupture/year Every time it ruptures ? 35% mortality rate