11.3 Assessment and Management of Head and Brain Injuries

Question 1

Intracranial Hematoma

Answer 1

• Collection of blood beneath the skull
• Includes epidural, subdural, intracerebral, subarachnoid

Question 2

Epidural Hematoma

Answer 2

• Bleeding between skull and dura
• Caused by laceration of an artery

Presentation
- Immediate post-traumatic unconsciousness followed by a “lucid interval”
- Can cause rapid deterioration of LOC with neurological decline
- May also see dilated pupils on the side of injury, seizures, and motor weakness

Treatment
- Surgical repair (unless its small and causes no neurological damage)

Question 3

Subdural Hematoma

Answer 3

• Bleeding between dura and arachnoid layer
• Caused by tearing of vein above brain surface

Presentation
- Bleeding is slower rate

Risk Factors
- Aging brain which may cause brain atrophy. This can cause increased bleeding before signs appear.

Question 4

Cerebral Contusion

Answer 4

• Bruising of brain tissue often associated with trauma and hematomas.

Examples
- Blunt trauma
- Penetrating wounds
- Acceleration/deceleration wounds
(Coup and Countrecoup bruising which is damage on one side of the brain and the opposite side)

Question 5

Concussion

Answer 5

• Mild head injury that causes temporary neurological dysfunction caused by an external source.

Symptoms
- Confusion
- Brief LOC
- Headache
- Intellectual impairment
- Memory loss

Post Concussion Syndrome
- Headache, dizziness, vertigo, tinnitus, hearing loss, blurred vision, sleep disorders, depression, noise

Question 6

Diffuse Axonal Injury (DAI)

Answer 6

• Primary injury of diffuse white matter that results in tearing or shearing of axons and small blood vessels.
• Can show decerebrate or decorticate positioning

Mild injury can cause cognitive disability
Major injury can cause long-term disability

Question 7

Chronic Traumatic Encephalopathy (CTE)

Answer 7

• Degenerative brain disease caused by repeated trauma

Symptoms
- Impaired judgment
- Aggression
- Impulse control problems

Diagnosis
- Autopsy (definitive)
- MRI can detect small lesions

Question 8

Primary vs Secondary Injuries

Answer 8

Primary
- Mechanical injury to the brain that is a direct result of initial insult

Secondary
- Result of bodies response to primary injury

Examples of Secondary
- Injury caused by cerebral ischemia which can cause cerebral infarction
- Respiratory insufficiency
- Sepsis hypotension
- Cerebral edema
- ICP

Question 9

Assessment Scales for Brain Injury

Answer 9

• Glasgow Coma Scale
• Functional Assessment Measures
• Disability Rating Scales

Rancho Los Amigos Scale Levels
- Measures level of response and amount of assistance needed

Question 10

Brain Injury Treatment

Answer 10

• No standard care due to diverse types
• Goal is to regain as much function and independence as possible while considering physical, cognitive, emotional and behavioral needs.

Question 11

Medications

Answer 11

Analgesics
Anti-anxiety medications
Anticoagulants
Anticonvulsants
Antidepressants
Antipsychotics (to prevent combativeness, hostility, hallucinations, and sleep disorders)
Muscle relaxants
Sedative-Hypnotic Agents (To induce sleep or depress the CNS response to pain, sleep, awareness)
Stimulants (to increase alertness and attention)