Assessment of the Patient

Question 1

What % of head trauma cases are polytrauma?

Answer 1

60%

Question 2

Define head trauma as a primary injury?

Answer 2

Immediate injury, as a result of the mechanical damage.

Question 3

Define head trauma as a secondary injury?

Answer 3

Which come minutes to days after the primary injury.

Question 4

Contusions, haematomas and lacerations are primary or secondary?

Answer 4

Prima

Question 5

The cranial vault is a rigid structure containing (3)

Answer 5

Brain tissue
Blood
Cerebrospinal fluid

Question 6

How does ICP increase?

Answer 6

An increase in the volume of any one of any of brain tissue, blood or CSF without a reduction in volume of one of the others

Question 7

What defines the relationship between contents of the crania and ICP?

Answer 7

Monro-Kellie Doctrine.

Question 8

In normal patients, as intracranial volume increases, the increase in ICP is initially prevented by a process of

Answer 8

isobaric spatial compensation

Question 9

What does isobaric spatial compensation involve?

Answer 9

This involves initial redistribution of cerebrospinal fluid (CSF) from the cranial vault to the spinal compartment.

Question 10

Once the process of isobaric spatial compensation is exhausted, what is the 2ry mechanism that commences?

Answer 10

blood also being redistributed away from the cranial vault.

Question 11

What happens once isobaric spatial compensation and 2ry mechanism exhausted?

Answer 11

further compensation is limited, and continuing increases in intracranial volume (ICV) will result in ICP increasing sharply.

Question 12

Maintenance of cerebral function is dependent on

Answer 12

Adequate blood being delivered to the brain

Question 13

What does adequate blood being delivered to the brain rely on?

Answer 13

Adequate cerebral perfusion pressure (CPP).

Question 14

Define cerebral perfusion pressure (CPP).

Include equation

Answer 14

the difference between mean arterial pressure (MAP) and ICP or cerebral venous pressure (CVP), whichever is greater.

CPP = MAP – ICP or CVP (whichever is the highest)

Question 15

If ICP increase, what also needs to increase to maintain cerebral perfusion?

Answer 15

MAP

Question 16

How does marked elevation in MAP lead to bradycardia?

Answer 16

Trigger a baroreceptor response, resulting in a subsequent bradycardia

Question 17

What is elevated MAP -> baroreceptor -> bradycardia known as?

Answer 17

Cushing response.

Question 18

With a head trauma, what extra-neurological lesions might be? (7)

Answer 18

Vascular

Respiratory

Cardiac

Abdominal

Musculoskeletal

Skin

Connective tissue.

Question 19

With a head trauma; What other assessments or basic diagnostics might you wish to perform prior to neurological assessment? (3)

Answer 19

Bloods; PVV, total solids, glucose, electrolyte
Imaging of abdo/thorax - bladder and thorax injuries
USG

Question 20

The aim of the neurological assessment with a head trauma?

Answer 20

Localize lesion
Determine prognosis

Question 21

What to evaluate on initial neuro assessment? (5)

Answer 21

Consciousness
Breathing pattern
Pupil size
Ocular position
Movement and motor response of ocular

Question 22

What scale to use to assess prognosis and monitor progress?

Answer 22

“Modified Glasgow Coma Scale”

Question 23

How often to repeat the “Modified Glasgow Coma Scale”?

Answer 23

30-60 mins

Question 24

What should the initial exam determine location wise following head trauma?

Answer 24

supratentorial (mostly affecting the forebrain) or infratentorial (mostly affecting cerebellum and caudal brainstem).

Question 25

Which aspect of the brain is the following located to: Seizures

Answer 25

Supra tentorial

Question 26

Define supra tentorial?

Answer 26

Mostly affecting forebrain

Question 27

Define infratentorial

Answer 27

Mostly affecting cerebellum and caudal brainstem

Question 28

Which aspect of the brain is the following located to: Nystagmus physiological can be decrease/absent

Answer 28

Infratentorial

Question 29

Which aspect of the brain is the following located to: Menace response can be altered

Answer 29

Supratentorial

Question 30

Which aspect of the brain is the following located to: Response to nasal stimulation can be altered

Answer 30

Supra tentorial

Question 31

Which aspect of the brain is the following located to: Palpebral reflex can be altered

Answer 31

Infra tentorial

Question 32

Which aspect of the brain is the following located to: PLRS can be altered/anisocira can be present

Answer 32

Infra tentorial

Question 33

Signs seen which would indicate supra tentorial? (3)

Answer 33

Seizures are common Menace response can be altered Response to nasal stimulation can be altered.

Question 34

Signs seen which would indicate infra tentorial? (3)

Answer 34

Palpebral reflex can be altered Nystagmus physiological can be decreased/absent or pathological nystagmus present PLRs can be altered / anisocoria can be present.

Question 35

What is the most reliable empiric measure of impaired cerebral function?

Answer 35

Level of consciousness

Question 36

What posture is associated with a poor prognosis?

Answer 36

comatose patient in decerebrate rigidity

Question 37

Which 2 ocular presentations are associated with a guarded prognosis?

Answer 37

Anisocoria Miosis

Question 38

What is anisocoria associated with lesion wise?

Answer 38

Unilateral compression/contusion Increased ICP

Question 39

What is miosis associated with following a head trauma?

Answer 39

Brainstem compression

Question 40

What trauma is non responsive mydriasis associated with?

Answer 40

Compression/contusion bilateral

Question 41

What is the prognosis with non responsive mydriasis?

Answer 41

Poor