๐ป๐๐๐๐๐๐๐๐ ๐ฉ๐๐๐๐ ๐ฐ๐๐๐๐๐ Flashcards
What is the definition of Traumatic Brain Injury?
A non-degenerative non-congenital insult to the brain from external mechanical force leading to permanent or temporary impairment of cognitive physical & psychological functions
What are the three most common causes of TBI according to the epidemiology?
Falls
Road traffic accidents
Assaults
What is the difference between Coup and Contrecoup injury?
Coup occurs under site of impact while Contrecoup occurs on opposite side of impact
What is the Monroe-Kellie doctrine?
The sum of volumes of brain, CSF & intracranial blood is constant
V(cranium) = V(brain) + V(CSF) + V(blood)
What is the formula for Cerebral Perfusion Pressure (CPP)?
CPP = MAP - ICP (Mean Arterial Pressure minus Intracranial Pressure)
What are the three indices of TBI severity?
Mild Moderate & Severe
What is primary injury in TBI?
Injury that occurs at the moment of initial trauma
What is secondary injury in TBI?
Injury that occurs as indirect result of initial trauma developing over time
Name three causes of primary injuries in TBI
Skull lacerations
Skull fractures
Contusions
Diffuse Axonal injury
Intracranial hemorrhage
What is the significance of CSF rhinorrhea?
It indicates anterior skull base fracture with CSF leakage
What are the three classifications of TBI spectrum (skull)?
Linear (displaced/undisplaced) Ping pong and Depressed (open/closed)
What is an extradural hematoma?
A surgical emergency with bleeding between skull and dura
Name three sources of extradural bleeding
Middle meningeal artery
Diploe of bone
Dural sinuses
What are the classifications of subdural hematoma?
Acute (0-3 days)
Subacute (4-21 days)
Chronic (>21 days)
What appears hyperdense on CT in subdural hematoma?
Fresh blood appears hyperdense in first 3 days. It is Acute
What is the source of bleeding in subdural hematoma?
Bleeding occurs via bridging veins
What is the classic CT appearance of contusions?
Salt & pepper appearance
What are four clinical presentations of subarachnoid hemorrhage?
Headache (worst headache of their life)
Loss of consciousness
Photophobia
Nausea/vomiting
Seizures
What is the treatment for acute epidural hematoma?
Craniotomy & hematoma evacuation
What is the best investigation for diffuse axonal injury?
Difficult to diagnose on CT requiring MRI
Name 5 secondary injuries in TBI
Dyselectrolytemia
Hypoglycemia
Hypertension
Seizures
Raised ICP
How does cerebral perfusion pressure relate to blood pressure?
CPP = SBP + 2DBP
โโโโโ โ ICP
3
What are Battleโs sign and Raccoon eyes?
Signs of base of skull fracture (periorbital ecchymosis and post-auricular ecchymosis)
What is the lucid interval?
Period of consciousness between impact and deterioration in EDH
What appears isodense on CT in subacute subdural hematoma?
Blood appears isodense between 4-21 days
What grade of diffuse axonal injury affects the brainstem?
Grade 3 (severe) reaching brainstem with high risk of coma
Name three clinical presentations of extradural hematoma
Lucid interval
Rhinorrhea
Severe headache
What determines surgical indications for depressed skull fracture?
Openly depressed significantly depressed or fracture through air sinus
What appears hypodense on CT in chronic subdural hematoma?
Old blood appears dark due to clot breakdown after 21 days
What is the classic shape of a CT finding in epidural hematoma?
Biconvex (lentiform) shape
Name four common clinical presentations of TBI
Headache
Confusion
Slurred speech
Vision changes
State the monroe-kellie principle
V(cranium) = V(brain) + V(CSF) + V(blood)
What grade of diffuse axonal injury affects white matter?
Grade 1 (mild) small injuries in white matter
What grade of DAI affects corpus callosum?
Grade 2 (moderate) damage extends to corpus callosum
What is the crescent shape on CT indicative of?
Subdural hematoma typically appears crescent-shaped
Name three clinical signs of increased ICP
Headache vomiting and altered consciousness
What imaging is recommended for suspected diffuse axonal injury?
MRI is recommended as CT may miss the injury
What causes the salt & pepper appearance in contusions?
Mixed areas of hyperdensity & hypodensity on CT
What are the five clinical presentations of intraventricular hemorrhage?
Altered consciousness
Bleeding from craniofacial orifices
Seizures
Amnesia
Vomiting
What does the Bโs in care of unconscious patients stand for?
Brain
Breathing
Blood
Bladder
Bowel
Body temperature
List the components of ATLS protocol examination for TBI
Glasgow Coma Scale
Pupils (contraction/fixed)
Head (nostrils/external auditory meatus/eyes/globe)
Check other injuries (chest/spine)
What investigations are required in TBI management?
CT brain (non-contrast)
C-spine imaging (X-ray/CT scan)
Trauma series
Blood work
Nexus criteria
What are the key steps in preventing secondary injuries?
ICP management
Normoglycemia
Prevent seizures/hyperthermia/electrolyte derangement
Free neck (avoid venous compression)
Analgesia
What are the cranial complications of TBI?
Post-traumatic seizures
Post-traumatic hydrocephalus
Post-traumatic depression
Persistent focal deficits
Cognitive deficits
What are the extracranial complications of TBI?
Endocrineโ (SIADH/CSW-cerebral salt wasting/hypopituitarism)
Respiratoryโ (pneumonia/atelectasis/aspiration)
CVSโ (DVT)
Name three behavioral/cognitive complications of TBI
Cognitive deficits, behavioral changes, communication deficits
What is included in the principle of TBI management?
ATLS, all the activities stated in examination, care of the unconscious
What are the main preventive measures for TBI?
Enforce road traffic laws, advocacy & campaigns, protect vulnerable groups, sports safety, occupational/road user safety
How should coma be managed in TBI?
Intubate & sedate
What is the importance of nurse 30ยฐ in TBI management?
To prevent increased intracranial pressure
What respiratory complications can occur after TBI?
Pneumonia, atelectasis, aspiration pneumonitis
What endocrine complications can occur after TBI?
SIADH, CSW, hypopituitarism
What is the significance of checking external auditory meatus in head examination?
To check for CSF otorrhea or bleeding indicating base of skull fracture
What are the CT findings of sub-arachnoid hematoma?
The subarachnoid space is Hyperdense
What are the classical CT findings of intra-cranial/intra-parenchymal haemorrhage
Hyperdense collection of blood with hypodense oedema
Irregular shape
Contusions have a salt & pepper appearance
What is the treatment of intra-ventricular haemorrhage?
Treatment of the underlying cause (aneurysm, hypertension)
What is the treatment of Subdural Haematoma?
Acuteโ Craniotomy
Sub-acuteโ Burr hole surgery
Classify TBI
Indices of severityโ mild, moderate & severe
Mechanism of injuryโ Contact/impact, Non-contact/inertial, Blast
Pathoanatomic type
Reference to suture linesโ Caput succedaneum, Subgaleal haemorrhage, Cephalohematoma
Presentationโ- Adult, child, neonate/infant
