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Central Nervous System 3. Traumatic Vascular Injuries

TRAUMATIC VASCULAR INJURY. Epidural Hematoma: Arterial bleedingFrom skull fracture related Middle meningeal artery tearBlood collects between the dura

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Central Nervous System 3. Traumatic Vascular Injuries

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    1. Central Nervous System 3. 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

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