ISSN 2398-2969      

Brainstem: contusion

icanis
Contributor(s):

Rodney Bagley

Synonym(s): head trauma


Introduction

  • See also brain tumor Brain: neoplasia , penetration wounds Brain: penetration wound and concussion Brain: cerebral concussion / contusion.
  • Cause: brain herniation Brain: tentorial herniation , or inflammatory brain disease.
  • May be edema, hemorrhage or disruption of nerve structure.
  • Signs: locomotor dysfunction, eg hemiparesis, decreased proprioception, cranial nerve abnormalities and altered mental status.
  • Diagnosis: CT, MRI.
  • Prognosis: lesions of supratentorial structures or the cerebellum have a better overall prognosis for recovery than lesions involving the brain stem.

Pathogenesis

Etiology

  • An impact to the head may result in a contusion without an associated skull fracture.
  • The acceleration and deceleration of the brain stem may result in injury.
  • Secondary effects of brain trauma are manyfold and linked to the pathophysiology.

Pathophysiology

  • Intracranial disease processes may result in mechanical disruption of intracranial tissues (primary injury).
  • This primary injury may initiate a number of secondary pathophysiological sequele such as:
    • Metabolic alterations in neuronal or glial cells.
    • Impairment of vascular supply to normal tissue (ischemia).
    • Impairment of cerebrovascular autoregulation, hemorrhage (intraparenchymal, intraventricular, extradural or subdural).
    • Irritation (seizure generation).
    • Obstruction of the ventricular system; edema formation, production of physiologically active products.
    • Increased intracranial pressure (ICP).
  • Injury to CNS → swelling and edema.
  • If raised PaCO2 occurs → increased cerebral blood flow which exacerbates situation.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bagley R S (1996) Pathophysiologic sequelae of intracranial disease. Vet Clin North Am 26 (4), 711-734 PubMed.
  • Dewey C W, Budsberg S C & Oliver Jr J E (1993) Principles of head trauma management in dogs and cats - Part II. Comp Contin Ed 15 (2), 177-193 VetMedResource.
  • Hall E D (1992) The neuroprotective pharmacology of methylprednisolone. J Neurosurg 76 (1), 13-22 PubMed.
  • Hall E D (1985) High-dose glucocorticoid treatment improves neurological recovery in head-injured mice. J Neurosurg 62 (6), 882-887 PubMed.
  • Kornegay J N, Oliver J E & Gorgacz E J (1983) Clinicopathologic features of brain herniation in animals. JAVMA 182 (10), 1111-1116 PubMed.
  • Tornheim P A, McLaurin R L & Thorpe J F (1976) The edema of cerebral contusion. Surg Neurol 5 (3), 171-175 PubMed.

Other sources of information

  • Wheeler S J (1995) In:Manual of Small Animal Neurology. West Sussex: British Small Animal Veterinary Association.
  • Bagley R S (1994)Pathophysiological effects of central nervous system tumor.In:Proceedings of the Twelth Annual Veterinary Medical forum.Washington DC, May 1994. pp 928-930.
  • Braund K G (1994)Clinical Syndromes.In:Veterinary Neurology. 2nd edn. St. Louis: Mosby.
  • Kornegay J N (1993)Pathogenesis of diseases of the central nervous system.In:Textbook of Small Animal Surgery. 2nd edn. Slatter D (ed). Philadelphia: W B Saunders. pp 1022-1037.
  • Chrisman C L (1991)Problems in Small Animal Neurology.2nd edn. Philadelphia: Lea & Febiger.
  • Shores A (1989)Craniocerebral trauma.In: Kirk RW (ed)Current Veterinary Therapy. 10th edn. Philadelphia: W B Saunders. pp 847-853.
  • deLahunta A (1983)Veterinary Neuroanatomy and Clinical Neurology.2nd edn. Philadelphia:W B Saunders.

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