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accumulation of blood btwn skull and dura mater. usually result of temporal bone fx and resulting lacertaion of middle meningial artery
presents with lucid interval, then decline in consciousness with rapid progression to coma then possibe uncal herniation.
CT shows lens-shaped hyperdense lesion
accumulation of blood between the dura mater and brain results from tearing of bridging veins which connect the surface of the brain and dural sinuses.
acute presentation with headache, contralateral hemiparesis, seizures, and wide variety of cortical dysfunction, sometimes increased ICP
chronic presentation after mild head trauma, esp in elderly, hemiparesis, seizures, and behavioral changes
CT - crescent-shaped hyperdensity that can cross suture lines
diffuse axonal injury
associated with severe head trauma, on CT multiple areas of punctate hemorrhage in deep white matter and corpus callosum. usually associated with poor prognosis
due to mild traumatic brain injury. headache, sleep disturbance, and psychological problems, including with mood
central (transtentorial) herniation
diffuse cerebral edema or large intracranial mass may cause downward herniation of the diencephalon through the tentorial notch. first decrease level of altertness, followed by small, reactive pupils due to disruption of sympathetic pathways from hypothalamus, then decorticate posturing. Midbrain compression causes fixed, midposition pupils and decerebrate posturing
usually due to expansion of mass located laterally in the brain, resulting in medial shift of uncus of the temporal lobe. preceded by hemiparesis sometimes. first see ipsilateral third nerve palsy, then impairment of consciousness, then compression of contralateral cerebral peduncle against the free edge of the tentorium, resulting in hemiplegia IPSILATERAL to herniating uncus. Alternatively, compression of posterior cerebral artery may produce medial temporal lobe or occipital lobe ischemia of infarction
due to expanding frontal lobe masses, causing herniation of the cingulate gyrus beneath the falx cerebri. May cause compression of anterior cerebral arteries which leads to leg weakness
Glascow Coma Scale
- 13-15 mild head injury
- 8-12 moderate
- 3-7 severe
Cerebral perfusion pressure
difference between mean arterial pressure and intracranial pressure