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Neuro Behavioral Med I > 11 - Intracranial Trauma > Flashcards

11 - Intracranial Trauma Flashcards

1
Q

What are the general types of brain trauma?

A
  • Penetrating
  • Skull FX
  • Bleeds
  • Diffuse axonal
  • Concussion
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2
Q

What are the signs and symptoms of brain trauma?

A
  • Raccoon eyes
  • Battle signs
  • CSF /blood in ear canal
  • Skull depression
  • Penetrating object
  • Confusion/memory loss
  • Neuro changes
  • Vital signs
  • Mechanism
  • Persistent vomiting
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3
Q

Describe the history tips for brain trauma

A
  • Trauma (mechanism)
  • Anticoags
  • Change in mental status (confusion/LOC)
  • Neuro deficits
  • What can be explained with intoxication???
  • Personality changes (case)
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4
Q

What three things does the Glasgow coma scale consider?

A
  • Eyes
  • Verbal
  • Motor
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5
Q

What do you need about the Glasgow scale for brain trauma?

A
  • A dead person has a Glasgow of 3 (but you can have a 3 and still be alive)
  • Normal is 15
  • 8 = intubate
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6
Q

What are the “triggers” for a brain CT?

A
  • Above s/s (before)
  • Any abnormal neuro exam
  • Mechanism
  • Anticoagulants and ANY hit to head ***
  • Too much etoh on board to eval

If you’re on anticoags, you get a CT

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7
Q

Describe the imaging studies you will run on brain trauma patients

A
  • CT no contrast give best images acutely…blood looks hyper dense (very white)
  • At 72 hours, the blood chemistry changes and the blood starts to look like brain…now CT with contrast or MRI is scan of choice
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8
Q

Describe a penetrating brain trauma

A
  • 35% of TBI (traumatic brain injury) deaths
  • GSW (gun shot wound) primary
  • How they look when they come in predictive of outcome when FB is removed
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9
Q

What is a basilar skull fracture?

A
  • Linear skull fx at base of skull
  • Can tear membranes of brain, leaking CSF
  • Raccoon eyes, csf in ears/nose, battle signs
  • High infection risk

Look behind ears for bruising - it can be anywhere on the base of the skull

CSF looks like yellowish fluid with some blood in it

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10
Q

What is a hematoma?

A

Just a collection of blood

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11
Q

What can a CT of the brain show you?

A
  • CT scan of brain looks for shear injury, bleed, stroke, tumor
  • Will NOT show a concussion ***
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12
Q

How do you treat a brain bleed?

A
  • ABCs
  • Intubate for Glasgow below 8 ***
  • If you have a long transport from hospital to hospital, intubate at 12
  • Stabilize the patient
  • Evacuate the bleed or watch and wait
  • If the patient is on coumadin, give vitamin K
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13
Q

What is the treatment for traumatic brain injury?

A
  • Craniotomy and evacuation for significant bleed (observe for smaller) so if your facility doesn’t do, need transfer
  • If patient has an obvious brain injury do NOT keep at small hospital to get CT – transfer to trauma center…time is brain***

THE TREATMENT FOR TRAUMA IS SURGERY

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14
Q

What are Burr holes?

A
  • Mainly makes for good TV (Izzy on Grey’s Anatomy)
  • Do not drill where skull depression but on side of the dilated pupil (if only one) and on the advice of a surgeon

This is not what is typically done - it is more of a last resort to save a life

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15
Q

What are the different types of brain bleeds and injuries?

A
  • Subdural Hematoma
  • Epidural hematoma
  • Intraventricular
  • Diffuse Axonal Injury
  • Subarachnoid
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16
Q

Describe the characteristics of a subdural hematoma

A
  • Most common type of bleed – present in 1/3 brain trauma
  • Mortality 20 – 50 % (depending on severity of bleed and comorbidities)
  • The very young and very old are at risk (shaken baby, older with brain atrophy)
  • Shaken baby - 24% head trauma in under 2 = child abuse

KNOW THE AGES

17
Q

Describe the bleed in a subdural hematoma

A
  • Path – low pressure venous bleeding of bridging veins…pulls arachnoid away from dura
  • Blood can cause increase ICP or direct pressure or ischemia
  • May cross suture lines
  • Crescent shapes
  • Usually not associated with skull fx
18
Q

How do you differentiate between a subdural or epidural hemorrhage?

A 
Subdural = whole brain 
Epi = half of the brain
19
Q

What are the risk factors for subdural hematoma?

A
  • Trauma especially with LOC
  • Anticoags (fall + anticoags = CT)
  • Hemophiliacs
  • Etoh abuse
20
Q

Describe the relationship between alcoholics and subdural hematomas

A

Why an increased risk?

  • Poor nutrition
  • Falls
  • Liver makes clotting factors
  • Brain atrophy
21
Q

What happens after a subdural crisis?

A
  • Recurrent hematoma
  • Infection
  • Seizures
22
Q

Describe the characteristics of a epidural hematoma

A
  • Bleeding between skull and dural layer – most have skull fractures
  • 1-2% head trauma
  • Mortality 5-43%
  • Injury stabilizes quickly…what they come in with is what they are left with
  • Age extremes
  • 20% “lucid interval” (frequent board question)
  • Lesion more localized, elliptical shaped
23
Q

What is an intraventricular bleed?

A
  • Usually from minor head trauma (one I saw was big etoh’er passed out…no neuro changes, felt great)
  • Usually watch
24
Q

What is a diffuse axonal injury?

A
  • Rapid acceleration-deceleration forces (car accident)
  • Often small changes on CT are huge changes in neuro status
  • Poor prognosis
  • Persistent vegetative state is common
  • A shaken baby can see this too
25
Q

What is the subarachinoid hemorrhage?

A

Very easy to miss, present like a headache, drive ER docs nuts
- Bleeding between arachnoid and pia layer
- Usually nontraumatic
- From rupture of AVM, tumor or Berry Aneurism
- What makes ER doctors nuts
6-25 per 100,000
- Intracranial

26
Q

What is the epidemiology of subarachnoid hemorrhage?

A
  • Women > men
  • Blacks > whites
  • Ave age = 50
  • HTN increases risk of rupture
27
Q

Describe the death rates in subarachnoid hemorrhage

A
  • Easy to miss
  • 10-15% die before arrival
  • 40% in a week
  • 50% in 6 mo
28
Q

What are the signs and symptoms of subarachnoid hemorrhage

A
  • Headache – worst of life, sudden “thunderclap” but most have a “prodromal” HA about 2 weeks prior
  • N/V/photophobia
  • LOC
  • Neuro changes in 25%
  • Seizure
29
Q

What is the treatment for a subarachnoid hemorrhage?

A
  • Usually clip the vessel or coil it
30
Q

Describe concussions

A
  • Any temporary loss of normal brain function
  • 300,000 in football players/yr
  • 60% college soccer players
  • 4-6X chance repeat
31
Q

What are the signs and symptoms of concussion?

A
  • Prolonged HA
  • Visual disturbances
  • Dizzy/balance
  • Memory/amnesia/confusion
  • Difficulty concentrating
  • Nausea and vomiting

Very aggressive about treating concussions now

32
Q

What is the “second impact” effect?

A
  • Second Impact
  • Hit again after incomplete concussion recovery – can lead to serious and permanent brain damage
  • Instant death can occur
  • Big risk boxing, football, hockey, soccer

Neuro Behavioral Med I (15 decks)

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