15. Head Trauma and Acute Intracranial Events Flashcards
What is cerebral contusion?
Bruising of the brain where blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks.
What are the coup and contre-coup of cerebral contusion?
Coup is the same side as the impact, contre-coup is the other side.
What is concussion?
Head injury with a temporary loss of brain injury.
What is post concussion syndrome?
A group of presentations that appear weeks-years after concussion due to structural problems or neuronal signalling problems.
What is diffuse axonal injury?
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.
What is a basilar skull fracture?
Bony fracture within the base of skull.
What are the clinical signs of basilar skull fracture?
Racoon eyes, CSF rhinorrhoea, CSF otorrhoea, battle sign, haemotympanum, bump.
How are basilar skull fractures managed?
Traumatic brain injury management, treat complications, elevate depressed skull fractures, surgery to fix persistent CSF leak.
What are the definitions of mild, moderate, and severe brain damage according to GCS?
Mild 13-15, moderate 9-12, severe 3-8.
What are the definitions of mild, moderate, and severe brain damage according to how long post-traumatic amnesia persists?
Mild <1 day, moderate 1-7 days, severe >7 days.
What are the definitions of mild, moderate, and severe brain damage according to how long loss of consciousness lasts?
Mild 0-30 minutes, moderate 30 mins-24 hours, severe >24 hours.
What are the criteria for urgent head CTs?
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.
What are the layers of the meninges outer to inner?
Dura mater (periosteal and meningeal layers), arachnoid, pia mater.
Where does blood collect in extradural haemorrhages?
Inner surface of skull and periosteal dura mater.
What causes extradural haemorrhages?
Trauma and/or skull fracture. Severance of middle meningeal artery commonly.
What is the presentation of extradural haemorrhage over time?
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.
What limits growth and spread of extradural haemorrhage?
The suture lines so it can only grow inwards.
What is the appearance of extradural haemorrhage on CT?
Lemon shaped white with midline shift and lateral ventricle compression.
What is the management of extradural haemorrhage?
ABCDE. If small, only conservative management and observation with neurological follow up is needed. If large, may need craniotomy and clot evacuation.
What are the complications of extradural haemorrhages?
Brain damage, coma, seizures, weakness, pseudoaneurysm, arteriovenous fistula.
Where does blood collect in subdural haemorrhages?
Between meningeal dura mater and arachnoid mater.
What are the three presentation types of subdural haemorrhage?
Acute <3 days, subacute 3-21 days, chronic >3 weeks.
What is a complication associated with subdural haemorrhage?
Bleeding due to shearing forces on cortical bridging veins.
What are the causes of subdural haemorrhage?
Trauma, can be spontaneous. Cerebral atrophy increases risk of rupture.
