Trauma is our topic.
Let’s take a look at all the different
manifestations of trauma and keep in mind
that when there is trauma,
there could be other neuropathologic issues
that might be taking place simultaneously.
Let’s take a look.
For whatever reason,
you got into an accident then
you flew out the windshield.
You got hit by a baseball.
Whatever it may be.
Skull fractures, trauma.
Specifically here though, let’s
say that the brain itself,
the tissue or the
parenchyma becomes injured.
There are specific clinical
descriptions that we then give these.
First, let’s talk about concussion.
not really Mike Tyson, he never
really got hit too much,
but maybe Muhammad Ali, a boxer.
Payton Manning, quarterback, football.
So these are sports in which
it’s pretty high contact.
The quarterback or boxer may get
hit in the head quite often
and may result in a concussion.
So what does a concussion
mean to you by definition?
A clinical syndrome of altered mental
status secondary to head injury,
typically brought up by a change
in momentum of the head, such as –
Let’s say a linebacker
coming at you
and he dives right into you.
And your head hits the ground,
momentum of the head,
resulting in a concussion.
A boxer for obvious reasons.
The operative word here is
transient neurologic dysfunction
including loss of consciousness, temporary
respiratory arrest and loss of reflexes.
The operative word, transient.
And obviously, in such severe contact
sports, especially football,
it has come under a lot of
scrutiny because of the hits that
take place to the
And all these concussions,
that the athlete or the
patient may then incur
may result in now--
We call this severe
form of concussion,
which may then result in finally traumatic
spongiform encephalopathy, right.
And in fact, there’s even a
movie called Concussion
in which Will Smith plays a role.
You may want to
take a look at it.
Rather interesting, especially
because you’re going to be a doctor
and you are one in
just a matter of time.
Amnesia may be present.
Now there are different
types of amnesia.
You can have the anterograde
or the retrograde, now.
Allow the name to speak to you.
If there’s concussion, a temporary,
transient loss of consciousness
and all of sudden you can’t remember
exactly as to what happened.
When? How far back?
Are we talking about what
happened when you’re a baby and
you maybe got, I don’t know,
thrown into the snow.
That’s actually a personal
story, but anyhow,
my point is those long-term
memories do exist.
So that’s retrograde.
If you cannot remember those
long-term memories from decades ago,
that’s your retrograde
type of amnesia.
And a concussion though, those
memories from way back when actually
will still exist so you’re okay there.
But the problem – Not the problem.
But the issue is you might
not exactly remember
as to what caused the
And this then refers to
as being anterograde.
And for that moment in time,
there’s every possibility that you do not
remember what happened a few moments prior.
And might be a little bit difficult
initially to create new memories,
you know, for that
moment in time.
But really, this is all
transient, isn’t it?
But it doesn’t mean
it’s not dangerous.
There’s a last statement here,
postconcussive neuropsychiatric syndromes.
This is no joke.
This is what I was talking
to you about earlier.
Make sure you know the
definition of concussion.
We’re doing trauma.
Specifically, it’s the brain tissue,
the parenchyma that becomes injured
and by definition, it’s altered mental
status or loss of consciousness.
But it’s all transient.
It might be an anterograde
type of amnesia
that’s taking place with an
intact, long-term memory.
But in the sequelae here,
if the patient continues to have concussion
after concussion after concussion,
the patient may then
develop what’s known as
where literally, the brain
looks like a sponge.
But this is traumatic
versus, earlier, we had talked
about a condition or prion disease
known as transmissible,
spongy form encephalopathy.
And of course, with traumatic,
there’s even movies that are coming
out in which it addresses it
and the sequelae here is something that you
very much need to take into consideration
in such patients who have history of
being involved in contact sports.
Continuing our discussion
of parenchyma injury,
this now brings us to contusion.
Is this clear?
Our previous discussion
This is contusion.
Now, what does that mean to you?
There’s a direct parenchymal
injury to the brain.
What does that mean?
Well baseball player or even, let’s
say, soft ball, whatever it may be
and the ball then hits the head.
And when it does, there’s a direct impact,
direct impact, to the parenchyma.
There’s a contusion.
Now, they are descriptions of what
kind of impact is taking place.
If the injury is at
the point of contact,
if the injury to the brain is at
the point of contact directly,
then we call this coup injury.
So cerebral injury at the
point of contact versus
what’s the opposite of coup?
Well, then you add in the
French word contre-.
So contrecoup injury means what?
That means that the point of injury is
the opposite of the point of contact.
So you got hit maybe perhaps
in the frontal lobe,
and then directly on
the opposite side,
is where you would actually
find the parenchymal contusion.
This is then referred
to as being contrecoup.
So coup or contrecoup is
referring to contusion.
And it’s referring to the fact that the
parenchyma itself has become injured.
If it’s concussion,
then you’re looking at it more or
less as kind of like a syndrome.
Upon injury to brain itself,
the patient is going to lose consciousness,
maybe suffer amnesia,
but it’s all temporary.
This is contusion.
And we have another type
of parenchymal injury.
This is called diffuse
By the definition, what
does that mean to you?
So therefore the injury to the white matter
due to, well, let me give you the patient.
The patient is on a rollercoaster
at the amusement part.
And repeatedly, I’m not
saying every single patient,
but when you go in a
rollercoaster, you are
putting yourself at risk
for sudden acceleration.
My head whips back.
Or deceleration, my head
whips forward, right?
Or an accident is my point.
So when this occurs, this may result
in a very, very serious matter called
diffuse axonal injury.
Literally, the axon gets twisted
and it gets stretched and it gets damaged
and as far as you’re concerned,
this is irreversible injury.
As far as you’re
concerned right now,
this is irreversible injury.
So where are you?
Around the ventricles.
Therefore we call this paraventricular
white matter and hippocampus,
or common areas where you might
find diffuse axonal injury
with such a history
of your patient.
Cerebral and cerebellar peduncles
will be other places where
this could be
locations of injury.
What happens to the axon?
twisting, poor prognosis.
So as much as the patient
is having fun during
the particular roller coaster ride or
whatever type of ride or an accident
that causes sudden
the complications are rather poor or should
I say rather grave with poor prognosis.
Let’s talk about traumatic
Subarachnoid, we actually have discussed
extensively and intraparenchymal.
What we will do and what I will do for you
is make sure that we delineate the differences
clearly between epidural and subdural.
Before we move on,
I need you to bring in some of
your neuroanatomy here, please.
And if it’s epidural, what
kind of blood vessel?
Remember, what's my topic?
So, I’m going to keep using
this example for you.
A child gets hit by a ball,
playing baseball or
whatever it may be.
And this then causes vascular
injury and may then result in
the blood vessel in the epidural
space, becoming injured.
And then resulting in what’s
known as a hematoma, okay?
And you should know that
particular blood vessel there.
It’s known as middle
And you have the subdural.
In the dura mater or subdural, the blood
vessel there would be what, please?
In the subarachnoid space, we’ve
talked about the circle of Willis,
berry aneurysm, if it ruptures, it may
result in subarachnoid hemorrhage.
In any point in time, you could have
intraparenchymal type of issue.
Our topic, traumatic vascular injury.