Acute Cranial Problems - brain injury and hemorrhages Flashcards
Head Injury
refers to any trauma to scalp, skull, or brain
Head trauma
refers mainly to cranio-cerebral trauma, which includes alteration in consciousness, regardless of the duration
- head trauma has high likelihood for poor outcome
Time periods of death from head trauma
- immediately after the injury (massive hemorrhage and shock)
- within 2 hrs after the injury (progressive worsening of bleeding)
- approx 3 weeks post injury (multi-system failure)
- majority of death from a head injury occur immediately after the injury
Types of Head Injuries:
- Scalp lacerations
- Skull fractures
Scalp Lacerations
Most common type of head trauma
Scalp is highly vascular - profuse bleeding
Major complications are blood loss and infection
Skull Fractures
Frequently occur with head trauma
- linear or depressed
- simple, comminuted, or compound
- closed or open
- location of fracture alters the presentation of the manifestations (basilar skull fracture - battle sign)
Signs of Head Injury
- Racoon eyes & rhinorrhea (CSF leaking from the nose)
- battle sign (postauricular ecchymosis) with otorrhea
- Halo or ring sign (a halo pattern on a bedsheet - yellowish ring encircles blood if CSF is present)
- CSF leak increases for meningitis
Brain injuries are categorized as:
diffuse (several areas of the brain)
focal (localized)
Diffuse brain injury
damage to brain cannot be localized e.g. concussion
Focal brain injury
Damage can be localized to a specific area of the brain e.g., contusion, hematoma
Classified of brain injury based on GCS:
Mild
Moderate
Severe
Mild (GCS score 13-15)
Moderate (GCS 9-12)
Severe (GCS 3-8)
Concussion
a sudden transient mechanical head injury with disruption of neural activity and a change in LOC
Signs of concussion (4)
Brief disruption in LOC
Amnesia
Headache
Short duration
Postconcussion syndrome
seen 2 weeks to 2 months post concussion
Symptoms of postconcussion syndrome (5)
- persistent headache
- lethargy
- personality & behavioural changes
- decreased short term memory, decreased attention span
- changes in intellectual ability
Chronic traumatic encephalopathy (CTE)
Degeneration in brain from repeated concussions
Diffuse axonal injury (DAI)
widespread axonal damage that occurs following mild, moderate, or severe traumatic brain injury (TBI)
- trauma changes the function of axon -> results in axon swelling
DAI clinical signs & symptoms
- decreased LOC
- increased ICP
- decortication, decerebration
- global cerebral edema
90% of pts with severe DAI remain in persistent vegetative state
Focal injury
Can be mild to severe; localized to an area of injury
Consists of laceration, contusions, hematomas, and cranial nerve injury
Laceration
tearing of brain tissue
often associated with penetrating injuries
severe tissue damage
contusion
- bruising of brain tissue within a local area
- coup-contrecoup injury noted:
Coup - contusions or lacerations occur both at the site of direct impact of brain on the skull
Contrecoup - at a secondary area of damage on opposite side away from injury, leading to multiple contused areas
Contusions or lacerations occur both at the site of direct impact and at a secondary area of damage on opposite side
Complications of Head Injury (4)
- Epidural hematoma
- Subdural hematoma
- Intraparenchymal hematoma
- Traumatic subarachnoid hemorrhage
Types of Subdural Hematoma
- acute subdural hematoma
- subacute subdural hematoma
- chronic subdural hematoma
Epidural Hematoma
from bleeding between dura & inner surface of skull
Often result of torn artery
Symptoms of epidural hematoma
- unconsciousness at the scene
- a brief lucid interval followed by decreased LOC
- headache, N/V
Subdural hematoma
from bleeding between dura matter & arachnoid layer of brain
usually venous in origin, thus, slower to develop
Acute subdural hematoma
signs within 48 hours of injury
increased ICP, decreased LOC, headache
Subacute subdural hematoma
- occur within 2-14 days of injury
- subdural hematoma may appear to enlarge over time
Chronic subdural hematoma
- develops over weeks or months after seemingly minor injury
- Peak incidence in 50s and 60s
Intraparenchymal hematoma
aka intracerebral hematoma
collection of blood within the parenchyma, from bleeding within brain tissue itself
- about 16% of head injuries
- usually occurs in the frontal and temporal lobes
traumatic subarachnoid hemorrhage
result of traumatic forces damaging the superficial vascular structures in subarachnoid space
may dispose pts to cerebral vasospasm and decreased CBF
Cerebral vasospasm - brain blood vessels narrow and block blood flow. fever, stiff neck, decreased LOC, hemiparalysis
