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18. Nervous System > 15. Head Trauma and Acute Intracranial Events > Flashcards

15. Head Trauma and Acute Intracranial Events Flashcards

1
Q

What is cerebral contusion?

A

Bruising of the brain where blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks.

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2
Q

What are the coup and contre-coup of cerebral contusion?

A

Coup is the same side as the impact, contre-coup is the other side.

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3
Q

What is concussion?

A

Head injury with a temporary loss of brain injury.

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4
Q

What is post concussion syndrome?

A

A group of presentations that appear weeks-years after concussion due to structural problems or neuronal signalling problems.

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5
Q

What is diffuse axonal injury?

A

Shearing of interface between grey and white matter following traumatic acceleration/deceleration or rotational injuries to the brain damaging the intracerebral axons and dendritic connections.

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6
Q

What is a basilar skull fracture?

A

Bony fracture within the base of skull.

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7
Q

What are the clinical signs of basilar skull fracture?

A

Racoon eyes, CSF rhinorrhoea, CSF otorrhoea, battle sign, haemotympanum, bump.

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8
Q

How are basilar skull fractures managed?

A

Traumatic brain injury management, treat complications, elevate depressed skull fractures, surgery to fix persistent CSF leak.

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9
Q

What are the definitions of mild, moderate, and severe brain damage according to GCS?

A

Mild 13-15, moderate 9-12, severe 3-8.

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10
Q

What are the definitions of mild, moderate, and severe brain damage according to how long post-traumatic amnesia persists?

A

Mild <1 day, moderate 1-7 days, severe >7 days.

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11
Q

What are the definitions of mild, moderate, and severe brain damage according to how long loss of consciousness lasts?

A

Mild 0-30 minutes, moderate 30 mins-24 hours, severe >24 hours.

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12
Q

What are the criteria for urgent head CTs?

A

Consciousness GCS <13 or <14 after 2 hours; neurological abnormality - seizure, loss of consciousness + age >65/coagulopathy/dangerous mechanism of injury/amnesia >30 mins; suspect open/depressed skull fracture; 2+ vomiting.

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13
Q

What are the layers of the meninges outer to inner?

A

Dura mater (periosteal and meningeal layers), arachnoid, pia mater.

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14
Q

Where does blood collect in extradural haemorrhages?

A

Inner surface of skull and periosteal dura mater.

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15
Q

What causes extradural haemorrhages?

A

Trauma and/or skull fracture. Severance of middle meningeal artery commonly.

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16
Q

What is the presentation of extradural haemorrhage over time?

A

Initially loss of consciousness due to impact of initial injury, then transient recovery period with headache ‘lucid interval’ for a short time, then haematoma enlarges so ICP is raised further and compresses brain causing rapidly deteriorating level of consciousness.

17
Q

What limits growth and spread of extradural haemorrhage?

A

The suture lines so it can only grow inwards.

18
Q

What is the appearance of extradural haemorrhage on CT?

A

Lemon shaped white with midline shift and lateral ventricle compression.

19
Q

What is the management of extradural haemorrhage?

A

ABCDE. If small, only conservative management and observation with neurological follow up is needed. If large, may need craniotomy and clot evacuation.

20
Q

What are the complications of extradural haemorrhages?

A

Brain damage, coma, seizures, weakness, pseudoaneurysm, arteriovenous fistula.

21
Q

Where does blood collect in subdural haemorrhages?

A

Between meningeal dura mater and arachnoid mater.

22
Q

What are the three presentation types of subdural haemorrhage?

A

Acute <3 days, subacute 3-21 days, chronic >3 weeks.

23
Q

What is a complication associated with subdural haemorrhage?

A

Bleeding due to shearing forces on cortical bridging veins.

24
Q

What are the causes of subdural haemorrhage?

A

Trauma, can be spontaneous. Cerebral atrophy increases risk of rupture.

25
Q

How does acute subdural haemorrhage normally present?

A

Head trauma.

26
Q

How does subacute/chronic subdural haemorrhage normally present?

A

In elderly with a vague or absent history of head trauma. May be with insidious onset of confusion and general cognitive decline.

27
Q

How do acute and chronic bleeds differ on CT imaging?

A

Acute bleeds are hyperdense (white), haematomas become progressively hypodense over time (darker).

28
Q

What is the appearance of subdural haemorrhage on CT scans and why?

A

Banana shape, blood can’t spread past the midline.

29
Q

How are subdural haemorrhages managed?

A

Small chronic haematomas are monitored with imaging, acute need immediate neurosurgical intervention to relieve RICP, symptomatic subacute/chronic need one or more burr holes.

30
Q

Where does blood collect in subarachnoid haemorrhages?

A

Between arachnoid mater and pia mater.

31
Q

What is the normal presentation of subarachnoid haemorrhage?

A

Middle aged patients <60 years, spontaneous presentation with thunderclap headache, meningism, nausea and vomiting, fever, neurological deficits, loss of consciousness.

32
Q

What is the cause of subarachnoid haemorrhages?

A

Spontaneous rupturing of berry aneurysm. Can be traumatic.

33
Q

What is the presentation of berry aneurysms?

A

Mostly asymptomatic (in 3% of population) but can cause symptoms if pressing on nearby structures.

34
Q

What are the risk factors of berry aneurysms and rupture?

A

Family history, hypertension, heavy alcohol consumption, abnormal connective tissue.

35
Q

What is the appearance of subarachnoid haemorrhage on CT?

A

Focal hyperdense areas. Not as bright as acute bleeds as mixes with CSF.

36
Q

How is diagnosis of subarachnoid haemorrhage aided?

A

By lumbar puncture to look for presence of RBCs and xanthochromia (yellow tinges). NOT IF RICP.

37
Q

What is the management of subarachnoid haemorrhages?

A

Stabilise the patient, prevent rebleeding, treat cerebral vasospasm, correct hyponatraemia, neurosurgical intervention if large bleed.

38
Q

What is the prognosis of subarachnoid haemorrhages?

A

Depends on GCS, mortality is 30-90%.

39
Q

What are the complications of subarachnoid haemorrhages?

A

Hydrocephalus, focal neurological deficits, coma, seizures, cognitive decline, frequent headaches, hypopituitarism.

18. Nervous System (17 decks)

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