- ملخص 2026د. إيمان
Types of Scalp Bruises (Contusions)
🟦 Subcutaneous: Collected between skin & aponeurosis. It is localized (circumscribed), small, and painful because it is under tension.
🟥 Subaponeurotic (Subgaleal): Collected under the aponeurosis. It is diffuse (large), soft, and less painful. Exam Tip: It causes "Black Eye" or bruising behind the ear because blood migrates freely.
2. Skull Fractures & Healing
🟦 Fissure Types: Diastatic (separates sutures, common in infants), linear , polar , bipolar and Multiple (crossing lines from multiple blows).
🟥 Healing Rule: Defects in the vault bone never repair with bone. They fill with a Fibrous Membrane (permanent infirmity).
🟦 Timeline: Membrane starts forming at 3 months and becomes thick/complete at 12 months.
3. Fracture Base of Skull (FBS)
🟥 Anterior Fossa: Damages CN I (Olfactory) & II (Optic). Causes Black Eye & nose bleeding.
🟦 Middle Fossa: Damages CN VII (Facial) & VIII (Auditory). Causes deafness & ear bleeding.
🟥 Posterior Fossa: Damages CN X, XI, XII. Causes visceral paralysis (bulbar palsy).
4. Traumatic Meningitis (vs. Pathological)
🟦 Traumatic: Onset is 1-2 weeks after injury. Pus collects at the scalp wound site. Organisms: Staph or Strept (secondary invaders).
🟥 Pathological: Caused by long-standing Otitis Media. Pus collects at the temporal bone. Onset is days (4-5).
5. Concussion
🟦 Definition: Sudden, transient loss of consciousness (5-15 mins) due to disturbance of the Reticular Formation.
🟥 Signs (Shock-like): Pale face, Low BP, Rapid weak pulse, shallow breathing, and abolished reflexes.
🟦 Fate: Complete recovery, Post-Concussion Syndrome (Amnesia, headache, irritability), or passes into Compression.
6. Lucid Interval
🟥 Concept: The "Talk and Die" phase. Temporary recovery between Concussion (unconscious) and Compression (unconscious again).
🟦 Significance: Classic in Extradural Hemorrhage.
🟥 Medicolegal: Patient may identify the assailant during this time. Defense may argue the blow wasn't fatal since the victim walked away initially. Rule: All concussion cases must be hospitalized 24h.
7. Compression
🟦 Signs (ICP): High BP, Slow Pulse (Vagal stimulation), and Effortless (projectile) vomiting.
🟥 Lateralization: The pupil on the injured side contracts then dilates (Fixed Dilated Pupil). Paralysis occurs on the opposite (contralateral) side
🟦 Hemorrhage in brain:
1- extradural hemorrhage: localized, usually traumatic due to tear of middle meningial artery
2- subdural hemorrhage: may be traumatic or pathological ( shake baby syndrome ) due to tear of subdural vessels
3- subarachnoid hemorrhage: usually pathological due to rupture of annurism of circle of Willis cause sudden death ☠️
4- intracerebral hemorrhage: cope or conture cope due to extension of subarachnoid hemorrhage