6- NEUROLOGICAL TRAUMA: HEAD AND SPINAL CORD INJURY

Question 1

Head Injuries

Answer 1

Head injury is a board classification that includes injury to
the scalp, skull or brain.

Question 2

Traumatic brain injury (TBI)

Answer 2

the most serious form of
head injury, which results in deterioration in cognitive,
physical emotional and independent functioning…these
impairments to cognitive abilities or physical functioning
may either be temporary or permanent and cause partial
or total disability or psychosocial impairment

Question 3

types of Brain Injury

Answer 3

Primary injury

Secondary injury

Question 4

Primary injury

Answer 4

due to the initial damage
• Contusions, lacerations, damage to blood vessels,
acceleration/deceleration injury, or foreign object
penetration

Question 5

Secondary injury

Answer 5

damage evolves after the initial insult
• Due to cerebral oedema, ischemia, or chemical
changes associated with the trauma

Question 6

Pathophysiology of Brain injury

Answer 6

Brain suffer traumatic injury
Brain swelling and bleeding increases intracranial volume
Rigid cranium allows no room expansion of contents so intracranial pressure increases
Pressure in blood vessels within the brain causes brain to slow down
cerebral hypoxia and ischemia may occur
intracranial pressure continues to rise. brain may herniate
cerebral blood flow ceases

Question 7

brain injury Manifestations

Answer 7

depend upon the severity and location of

the injury

Question 8

Scalp wounds signs

Answer 8

Tend to bleed heavily; scalp wounds are also portals for infection

Question 9

Skull fractures signs

Answer 9

Usually have localized, persistent pain
◦ Fractures of the base of the skull
 Bleeding from nose, pharynx, or ears
 Battle’s sign: ecchymosis behind the ear
 CSF leak— halo sign —
ring of fluid around the blood stain from drainage

Question 10

Closed brain injury (blunt trauma):

Answer 10

acceleration/deceleration injury
occurs when the head accelerates and then rapidly decelerates,
damaging brain tissue

Question 11

Open brain injury

Answer 11

object penetrates the brain or trauma is so severe

that the scalp and skull are opened

Question 12

Concussion

Answer 12

a temporary loss of consciousness with no apparent

structural damage

Question 13

Contusion

Answer 13

more severe injury with possible surface haemorrhage
• Symptoms and recovery depend upon the amount of damage and
associated cerebral oedema
• Longer period of unconsciousness with more symptoms of
neurological deficits and changes in vital signs

Question 14

Diffuse axonal injury

Answer 14

widespread axon damage in the
brain seen with head trauma. Patient develops immediate
coma.

Question 15

Intracranial bleeding

Answer 15

• Extradural haematoma
• Subdural haematoma
• Acute and subacute
• Chronic
• Intracerebral haemorrhage and haematoma

Question 16

Extradural (Epidural) Haematoma

Answer 16

Blood collection in the space between the skull and the dura
 Usually associated with fracture of the temporal bone and
rupture of the meningeal artery
• Patient may have a brief loss of consciousness with return of
lucid state; then, as haematoma expands, increased ICP will
often suddenly reduce LOC
• An emergency situation!

Question 17

Subdural Haematoma

Answer 17

Collection of blood between the dura and the brain

Question 18

Acute: symptoms Subdural Haematoma

Answer 18

develop over 24 to 48 hours

Question 19

Subacute symptoms Subdural Haematoma

Answer 19

symptoms develop over 48 hours to 2
weeks
• Requires immediate craniotomy and control of ICP

Question 20

Chronic Subdural Haematoma

Answer 20

• Develops over weeks to months
• Causative injury may be minor and forgotten
• Clinical signs and symptoms may fluctuate
• Treatment is evacuation of the clot
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