Acute Cranial Problems - brain injury and hemorrhages

Question 1

Head Injury

Answer 1

refers to any trauma to scalp, skull, or brain

Question 2

Head trauma

Answer 2

refers mainly to cranio-cerebral trauma, which includes alteration in consciousness, regardless of the duration
- head trauma has high likelihood for poor outcome

Question 3

Time periods of death from head trauma

Answer 3

• 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

Question 4

Types of Head Injuries:

Answer 4

• Scalp lacerations
• Skull fractures

Question 5

Scalp Lacerations

Answer 5

Most common type of head trauma
Scalp is highly vascular - profuse bleeding
Major complications are blood loss and infection

Question 6

Skull Fractures

Answer 6

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)

Question 7

Signs of Head Injury

Answer 7

• 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

Question 8

Brain injuries are categorized as:

Answer 8

diffuse (several areas of the brain)
focal (localized)

Question 9

Diffuse brain injury

Answer 9

damage to brain cannot be localized e.g. concussion

Question 10

Focal brain injury

Answer 10

Damage can be localized to a specific area of the brain e.g., contusion, hematoma

Question 11

Classified of brain injury based on GCS:
Mild
Moderate
Severe

Answer 11

Mild (GCS score 13-15)
Moderate (GCS 9-12)
Severe (GCS 3-8)

Question 12

Concussion

Answer 12

a sudden transient mechanical head injury with disruption of neural activity and a change in LOC

Question 13

Signs of concussion (4)

Answer 13

Brief disruption in LOC
Amnesia
Headache
Short duration

Question 14

Postconcussion syndrome

Answer 14

seen 2 weeks to 2 months post concussion

Question 15

Symptoms of postconcussion syndrome (5)

Answer 15

• persistent headache
• lethargy
• personality & behavioural changes
• decreased short term memory, decreased attention span
• changes in intellectual ability

Question 16

Chronic traumatic encephalopathy (CTE)

Answer 16

Degeneration in brain from repeated concussions

Question 17

Diffuse axonal injury (DAI)

Answer 17

widespread axonal damage that occurs following mild, moderate, or severe traumatic brain injury (TBI)
- trauma changes the function of axon -> results in axon swelling

Question 18

DAI clinical signs & symptoms

Answer 18

• decreased LOC
• increased ICP
• decortication, decerebration
• global cerebral edema
  90% of pts with severe DAI remain in persistent vegetative state

Question 19

Focal injury

Answer 19

Can be mild to severe; localized to an area of injury
Consists of laceration, contusions, hematomas, and cranial nerve injury

Question 20

Laceration

Answer 20

tearing of brain tissue
often associated with penetrating injuries
severe tissue damage

Question 21

contusion

Answer 21

• 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

Question 22

Complications of Head Injury (4)

Answer 22

• Epidural hematoma
• Subdural hematoma
• Intraparenchymal hematoma
• Traumatic subarachnoid hemorrhage

Question 23

Types of Subdural Hematoma

Answer 23

• acute subdural hematoma
• subacute subdural hematoma
• chronic subdural hematoma

Question 24

Epidural Hematoma

Answer 24

from bleeding between dura & inner surface of skull
Often result of torn artery

Question 25

Symptoms of epidural hematoma

Answer 25

• unconsciousness at the scene
• a brief lucid interval followed by decreased LOC
• headache, N/V

Question 26

Subdural hematoma

Answer 26

from bleeding between dura matter & arachnoid layer of brain
usually venous in origin, thus, slower to develop

Question 27

Acute subdural hematoma

Answer 27

signs within 48 hours of injury
increased ICP, decreased LOC, headache

Question 28

Subacute subdural hematoma

Answer 28

• occur within 2-14 days of injury
• subdural hematoma may appear to enlarge over time

Question 29

Chronic subdural hematoma

Answer 29

• develops over weeks or months after seemingly minor injury
• Peak incidence in 50s and 60s

Question 30

Intraparenchymal hematoma

Answer 30

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

Question 31

traumatic subarachnoid hemorrhage

Answer 31

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