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A head injury is any injury that results in trauma to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries.
An intracranial aneurysm, also known as a cerebral aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.
Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compression of brain tissue and blood vessels. Symptoms vary based on the location and extent of edema and generally include headaches, nausea, vomiting, seizures, drowsiness, visual disturbances, dizziness, and in severe cases, death.
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 mmHg for a supine adult. The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF.
Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. Symptoms may include a severe headache of rapid onset, vomiting, decreased level of consciousness, fever, weakness, numbness, and sometimes seizures. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed.
A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually but not always associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space.
Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds. More often than not it ends in a lethal outcome.
Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Complications may include seizures.
A penetrating head injury, or open head injury, is a head injury in which the dura mater, the outer layer of the meninges, is breached. Penetrating injury can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are driven into the brain. Head injuries caused by penetrating trauma are serious medical emergencies and may cause permanent disability or death.
Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.
A thunderclap headache is a headache that is severe and has a sudden onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. Although approximately 75% are attributed to "primary" headaches—headache disorder, non-specific headache, idiopathic thunderclap headache, or uncertain headache disorder—the remainder are secondary to other causes, which can include some extremely dangerous acute conditions, as well as infections and other conditions. Usually, further investigations are performed to identify the underlying cause.
Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. An ICH is one kind of bleeding within the skull and one kind of stroke. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often, symptoms get worse over time. Fever is also common.
A subdural hygroma (SDG) is a collection of cerebrospinal fluid (CSF), without blood, located under the dural membrane of the brain. Most subdural hygromas are believed to be derived from chronic subdural hematomas. They are commonly seen in elderly people after minor trauma but can also be seen in children following infection or trauma. One of the common causes of subdural hygroma is a sudden decrease in pressure as a result of placing a ventricular shunt. This can lead to leakage of CSF into the subdural space especially in cases with moderate to severe brain atrophy. In these cases the symptoms such as mild fever, headache, drowsiness and confusion can be seen, which are relieved by draining this subdural fluid.
Osmotherapy is the use of osmotically active substances to reduce the volume of intracranial contents. Osmotherapy serves as the primary medical treatment for cerebral edema. The primary purpose of osmotherapy is to improve elasticity and decrease intracranial volume by removing free water, accumulated as a result of cerebral edema, from brain's extracellular and intracellular space into vascular compartment by creating an osmotic gradient between the blood and brain. Normal serum osmolality ranges from 280 to 290 mOsm/kg and serum osmolality to cause water removal from brain without much side effects ranges from 300 to 320 mOsm/kg. Usually, 90 mL of space is created in the intracranial vault by 1.6% reduction in brain water content. Osmotherapy has cerebral dehydrating effects. The main goal of osmotherapy is to decrease intracranial pressure (ICP) by shifting excess fluid from brain. This is accomplished by intravenous administration of osmotic agents which increase serum osmolality in order to shift excess fluid from intracellular or extracellular space of the brain to intravascular compartment. The resulting brain shrinkage effectively reduces intracranial volume and decreases ICP.
Midline shift is a shift of the brain past its center line. The sign may be evident on neuroimaging such as CT scanning. The sign is considered ominous because it is commonly associated with a distortion of the brain stem that can cause serious dysfunction evidenced by abnormal posturing and failure of the pupils to constrict in response to light. Midline shift is often associated with high intracranial pressure (ICP), which can be deadly. In fact, midline shift is a measure of ICP; presence of the former is an indication of the latter. Presence of midline shift is an indication for neurosurgeons to take measures to monitor and control ICP. Immediate surgery may be indicated when there is a midline shift of over 5 mm. The sign can be caused by conditions including traumatic brain injury, stroke, hematoma, or birth deformity that leads to a raised intracranial pressure.
In medicine, the dense artery sign or hyperdense artery sign is an increased radiodensity of an artery as seen on computer tomography (CT) scans, and is a radiologic sign of early ischemic stroke. In earlier studies of medical imaging in patients with strokes, it was the earliest sign of ischemic stroke in a significant minority of cases. Its appearance portends a poor prognosis for the patient.
Joshua B. Bederson is an American neurosurgeon, Leonard I. Malis, MD/Corinne and Joseph Graber Professor of Neurosurgery, and Chair of Neurosurgery at the Mount Sinai Health System in New York City. He is a Fellow of the American College of Surgeons and an attending neurosurgeon at The Mount Sinai Hospital and Elmhurst Hospital in Elmhurst, Queens.
Computed tomography of the head uses a series of X-rays in a CT scan of the head taken from many different directions; the resulting data is transformed into a series of cross sections of the brain using a computer program. CT images of the head are used to investigate and diagnose brain injuries and other neurological conditions, as well as other conditions involving the skull or sinuses; it used to guide some brain surgery procedures as well. CT scans expose the person getting them to ionizing radiation which has a risk of eventually causing cancer; some people have allergic reactions to contrast agents that are used in some CT procedures.
The white cerebellum sign, also known as reversal sign or dense cerebellum sign, is a radiological sign denoting the relatively white appearance of the cerebellum due to a generalized decrease in density of the supratentorial brain structures caused by extensive edema.
Fogging phenomenon in computerized tomography (CT) scanning of the head is vanishing signs of an infarct on the serial CT imaging in a patient with a recent stroke. It is a reversal of the hypodensity on the CT after an acute ischemic stroke. This happens as a result of re-nourishment of the infarcted area in subacute phase about one to three weeks after the stroke. In fact, resolution of the edema, which was caused by the accident, leads to increased attenuation of infarcted area that may regain near-normal density and mask the stroke. However, in the third week, parenchymal volume loss commonly appears as a hypoattenuation with a negative mass effect (shrinkage).
References
- ↑ Dixon, Andrew. "Pseudosubarachnoid hemorrhage | Radiology Reference Article | Radiopaedia.org". Radiopaedia.
- ↑ Given, Curtis A.; Burdette, Jonathan H.; Elster, Allen D.; Williams, Daniel W. (1 February 2003). "Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall Associated with Diffuse Cerebral Edema". AJNR. American Journal of Neuroradiology. 24 (2): 254–256. PMC 7974121 . PMID 12591643.
- ↑ Marder, Carrie P.; Narla, Vinod; Fink, James R.; Tozer Fink, Kathleen R. (26 December 2013). "Subarachnoid Hemorrhage: Beyond Aneurysms". American Journal of Roentgenology. 202 (1): 25–37. doi:10.2214/AJR.12.9749. PMID 24370126.
- ↑ Coulier, Bruno (1 March 2018). "Pseudo-subarachnoid Hemorrhage". Journal of the Belgian Society of Radiology. 102 (1): 32. doi: 10.5334/jbsr.1509 . PMC 6032606 . PMID 30039044.
- ↑ Ramanathan, Ramnath Santosh (2018). "Pseudo-subarachnoid Hemorrhage Sign". Annals of Indian Academy of Neurology. 21 (1): 83–84. doi: 10.4103/aian.AIAN_152_17 . PMC 5909155 . PMID 29720807.
- ↑ "Pseudo-Subarachnoid Hemorrhage after Cardiac Arrest". The Western Journal of Emergency Medicine. 31 May 2020.
Sources
- Xavier, João; Vasconcelos, Cristiana; Ramos, Cristina (2018). Diagnostic and Therapeutic Neuroradiology: A Case-Based Guide to Good Practice. Springer. p. 207. ISBN 978-3-319-61140-2.
- Caplan, Louis R. (2016). Caplan's Stroke: A Clinical Approach. Cambridge University Press. pp. 368–69. ISBN 978-1-316-55279-7.
- Kleinman, Paul K. (2015). Diagnostic Imaging of Child Abuse. Cambridge University Press. p. 406. ISBN 978-1-316-29818-3.
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