BLOCK 12 WEEK 6 Flashcards
1
Q
NON INVASIVE BRAIN IMAGING
A
2
Q
ULTRASOUND
A
Pros:
- live images
- no radiation
- Cross sectional images allow for the visualisation of structures
- Relatively portable imaging modality
Con:
- Low spacial resolution
3
Q
ULTRASOUND
A
- you know what your looking at by seeing where the probe is placed but its not very clear hence the low ‘spacial resolution’
4
Q
A
X- RAYS used for:
- Skull fractures
- Sutures
- Haemorrhage
X -rays:
- Normally a erect PA image is taken and a abdominal supine AP.
- You need at least 2 projections to determine anatomic placement.
5
Q
X RAYS
A
6
Q
A
7
Q
A
8
Q
CT SCANS
A
- CT scans are used to image structures associated with the brain but not the brain itself e.g. odema, bone fractures and HAEMORRHAGE
9
Q
CT SCANS
A
- CT scans are measured on a HOUNSFIELD SCALE normal X-Rays are not
PROS:
- Cross sectional images which allow for the easy visualisation of structures
- Easy to tell the differences between tissues
CONS:
- Relatively high radiation dose
- Relatively high cost
10
Q
A
11
Q
MRI
A
MRI are to do with water
- Bone and air have no water so appear black
- Tissues with water appear white to grey
- Tissues with a high amount of signal will appear white
- Tissues with a low level of signal will appear grey
What can we see:
An MRI scanner can be used to examine almost any part of the body including:
Brain and spinal chord / bones and joints / breasts / heart and blood vessels / internal organs such as the liver, womb or prostate gland.
12
Q
MRIs
A
MRI Imaging can be:
-T1
-T2
-Fat Saturated Images
-Vascular Contrast Images
How does MRI scan work?
-The human body is about 70% water
-Water molecules are made up of hydrogen and oxygen atoms
At the centre of each hydrogen atom is an even smaller particle called a proton. Protons are tiny magnets and are very sensitive to magnetic fields.
When you lie under a powerful scanner magnet, the protons in your body line up in the same direction, in the same way that a magnet can pull the needle of a compass.
Short bursts of radio waves are then sent to certain areas of the body, knocking the protons out of the alignment.
When the radio waves are turned off, the protons realign. This sends out radio signals, which are picked up by receivers.
These signals give information about the exact location of the protons in the body.
They also help to distinguish between various types of tissues in the body, because the protons in different types of tissues realign at different speeds and produce distinct signals.
In the same way that millions of pixels con a computer can produce complex pictures, the signals from the millions of protons in the body are combines to create a detailed image.
Magnets on – atoms align
Radiofrequency on – atoms disperse
Radiofrequency off – the atoms re-align releasing energy ( different for each tissue type).
Pros:
- good spatial resolution
13
Q
A
14
Q
T1 weighted image
A
- The timing of radiofrequency pulse sequences used to make T1 images results in images which highlight FAT tissue within the body.
-T1 – ONE tissue is bright: fat
15
Q
T2 weighted image
A
- The timing of radiofrequency pulse sequences used to make T2 images results in images which highlight FAT and WATER within the body.
-T2 – TWO tissues are bright: fat and water
16
Q
T1 and T2 images
A
17
Q
A
18
Q
Fluid attenuated inversion recovery (FLAIR) MRI
A
- FLAIR is also similar to T2, however, the CSF signal is nullified. This is particularly useful for evaluating structures in the central nervous system (CNS), including the periventricular areas, sulci, and gyri.
- For example, FLAIR can be used to identify plaques in multiple sclerosis, subtle oedema after a stroke, and pathology in other conditions whereby CSF may interfere with interpretation
19
Q
MRI (ANGIOGRAPHY)
A
Clinical use:
- Artherosclerosis (plaques)
- Stenosis (narrowing)
- Aneurysms
- Atriovenous malformations
- Interventional radiology - guide stent placement
20
Q
DIFFUSION WEIGHTED IMAGING (DWI)
A
DWI is an imaging modality that combines T2 images with the diffusion of water.
-With DWI scans, ischaemia can be visualised within minutes of it occurring (Figure 5).
- This is because DWI has a high sensitivity for water diffusion, thereby detecting the physiological changes that happen immediately after a stroke.
21
Q
PET SCAN
A
- Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body.
- PET scans are often combined with CT scans to produce even more detailed images. This is known as a PET-CT scan. With MRI its a PET-MRI.
-
22
Q
Why PET scans are used?
A
A PET scan can show how well certain parts of your body are working, rather than simply showing what they look like.
PET scans are particularly helpful for investigating confirmed cases of cancer to determine how far the cancer has spread and how well it’s responding to treatment.
PET scans are sometimes used to help plan operations, such as a coronary artery bypass graft or brain surgery for epilepsy.
23
Q
HOW PET SCANS WORK?
A
- PET scanners work by detecting the radiation given off by a substance injected into your arm called a radiotracer as it collects in different parts of your body.
- In most PET scans a radiotracer called fluorodeoxyglucose (FDG) is used, which is similar to naturally occurring glucose (a type of sugar) so your body treats it in a similar way.
- By analysing the areas where the radiotracer does and does not build up, it’s possible to work out how certain body functions are working.
- For example, using FDG in the body’s tissues can help identify cancerous cells because they use glucose at a much faster rate than normal cells.
24
Q
PROCESS OF A PET SCAN
A
- The radiotracer is injected into a vein in your arm or hand about an hour before your scan, as it takes time for it to reach the right cells in your body.
- During the scan, you lie on a flat bed that’s moved into a large, cylindrical scanner.
-The scan usually takes 30 to 60 minutes.
- ut the amount of radiation you’re exposed to in a standard PET scan is safe.
-The radiotracer becomes quickly less radioactive over time and will usually be passed out of your body naturally within a few hours.
- Drinking plenty of fluid after the scan can help flush it from your body.
25
PET PHYSICS
- The radioisotope decays as it is in the body from carbon to boron, as the radioisotope decays it releases a positively charged particle a positron
- The positron hits an electron which emits two gamma rays in opposite directions, which are detected simultaneously by opposite sides of the scanner
- Detectors are composed of scintillation crystals and photomultipliers
- Gamma rays are detected and converted to signal intensity, which the computer transforms into a spatial image.
26
SPECT - SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
- Similar to PET but uses different radioactive tracers
- Lower spacial resolution
- Less expensive than PET
- Can use long lived radioisotopes which are easier to obtain
27
EEG
- Electroencephalography
- To find where to put the electrodes, first the technician marks four points on your head - the nasion (indentation between the forehead and the nose), the inion (ridge that can be felt in the middle of the back of the skull, over the occipital area), and the preauricular points on both sides of the head (indentations above the outer part of the ear openings).
-The electrode are then placed in many areas on the head, at specific locations and distances from these landmarks or points listed above.
- Sometimes other electrodes (sphenoidal and suboccipital, for instance) are placed to increase the chance of recording EEG waves from areas that may be too small or too deep to be recorded by the usual electrodes.
-Epilepsy is the fourth most common neurological disorder in the world. If you have epilepsy, surges of electrical activity in your brain can cause recurring seizures.
-
28
ECoG
What is electrocorticography used for?
Electrocorticogram (ECoG), obtained by placing macroelectrodes (typically 2–3 mm diameter) on the exposed surface of the cortex, is widely used by neurosurgeons to identify the source of seizures in drug-resistant epileptic patients. The brain area responsible for seizures is subsequently surgically removed.
29
MEG
What is Magnetoencephalography used for?
Magnetoencephalography (MEG) is a noninvasive test that neurologists and neurosurgeons use to help plan brain surgeries for epilepsy and tumor removal. MEG maps out the sensory areas of your brain and can pinpoint the exact location where seizures originate.
30
WHERE ARE THE SCANNERS?
31
32
FMRI image
33
FUNCTIONAL MRI
- Monitors the brains activity in real time
- Measures the Blood Oxygen Level Dependent (BOLD) response
- Rapid neuron firing needs more energy
- Blood delivers more energy to active neurons than inactive neurons
- This imaging technique is mainly used for research not clinically
- can be used to see brain plasticity
34
NEUROPLASTICITY
- Neuroplasticity, also known as neural plasticity or brain plasticity, is the ability of neural networks in the brain to change through growth and reorganization. It is when the brain is rewired to function in some way that differs from how it previously functioned.
- neuroplasticity include learning a new language, practicing music, or memorizing how to navigate around your city. It can also occur if you lose a sense, such as hearing or sight.
35
FUNCTIONAL NEAR INFRARED SPECTROSCOPY (fNIRS)
36
-100,00 people in the UK suffer from a stroke each year in the UK
- Stroke is the single biggest cause of severe disability in the UK
37
TIA Diagnosis
- TIA diagnosis is always made using a RETROSPECTIVE history because symptoms resolve by the time a patient is seen by a doctor
38
39
FOCAL NEUROLGICAL DEFECIT
- A focal neurologic deficit is a problem with nerve, spinal cord, or brain function.
-It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue.
-Speech, vision, and hearing problems are also considered focal neurological deficits
40
NEUROLOGICAL DEFICIT
A neurologic deficit refers to abnormal function of a body area. This altered function is due to injury of the brain, spinal cord, muscles, or nerves.
Examples include:
-Abnormal reflexes
-Inability to speak
-Decreased sensation
-Loss of balance
-Mental function problems, such as memory loss
-Vision changes
-Walking problems
-Weakness of the arms or legs
41
WHAT ARE MIMICS OF STROKE
- SEIZURES
- MIGRAINES
- METABOLIC ENCEPHALOPATHY
- PERIPHERAL VESTIBULOPATHY
- FUNCTIONAL
42
TINNITUS
-Tinnitus is the term for hearing sounds that come from inside your body, rather than from an outside source.
- It's often described as “ringing in the ears”, although several sounds can be heard, including: buzzing. humming. grinding
43
- HISTORY cannot differentiate ischemic from hemorrhagic stroke
- 30-50 % of patients referred to a TIA clinic end up having something else instead TIA
44
ASSESMENT METHODS
- FAST
- BE FAST (balance loss, eyesight changes)
HOSPITAL ASSESSMENT TOOLs:
- The ROSIER tool (Recognition Of Stroke In the Emergency Room) gives a score based on the clinical features and duration. Stroke is possible in patients scoring one or more.
45
ROSIER
46
WHAT ARE WE IMAGING?
IMAGING ENABLES:
- intiation of appropriate treatment
- provision of information about prognosis
- information on stroke aetiology
What are we imaging 4Ps?
- PARENCHYMA - assess the early signs of acute stroke, rule out haemorrhage and some stroke mimmics
- PIPES (blood vessels): Assess the extracranial and intercranial circulation
- PERFUSION: assess the cerebral blood volume, cerebral blood flow and mean transit time
- PENUMBRA: Assess tissue at risk of dying if ischemia continues without repruscussion
47
ADVANTAGES AND DISADVANTAGES OF CT
Advantages:
- sensitive to haemorage
- non invasive
- inexpensive
- rapid image aqcuisition
Disadvantages:
- difficult to distinguish from chronic infarction
- poor imaging of the posterior fossa
- less sensitive for acute infarction
48
ADVANTAGES and DISADVANTAGES OF MRI
ADVANTAGES:
- no radiation
- more sensitive than CT for detection of ischaemia
- high soft tissue resolution
- you can diffrentiate old from acute infarction
DISADVANTAGES:
- more limited availability particularly out of hours
- more expensive
- less rapid image acqusition
- patient related factors like pacemakers and metal fragments
49
50
WHAT HAPPENS TO FRONTAL AND PARIETAL LOBES?
51
FUNCTION OF PARIETAL AND OCCIPITAL LOBE
52
FUNCTION OF CEREBELLUM
53
Heamorrhagic stroke accounts for about 50% of disability and mortality to do with stroke.
- ICH has a 40% to 50% mortality rate within 30 days,
54
WHAT CAUSES HAEMORRHAGIC STROKE
- HYPERTENSION
- ARTERO-VENOUS MALFORMATION (AVM)
- ANEURYSM
- CEREBRAL AMYLOID ANGIOPATHY (CAA)
- COAGULATION DISORDERS OR MEDICATION RELATED
55
HEMIPLEGIA
- paralysis which only affects one side of your body
56
HEMANOPIA
is a loss of vision or blindness in half the visual field, to either the right or left side
Homonymous hemianopsia (or homonymous hemianopia, HH) is a field loss deficit in the same halves of the visual field of each eye.
57
GAZE PALSY
is inability to move both eyes together in a single horizontal (most commonly) or vertical direction.
58
STROKE LARGE VESSEL OCCLUSION
59
60
BAMFORD CLASSIFICATION OF ISCHAEMIC STROKE
- The most commonly used classification system for ischaemic stroke is the Bamford classification system (also known as the Oxford classification system).
- This system categorises stroke based on the initial presenting symptoms and clinical signs.
- This system does not require imaging to classify the stroke, instead, it is based on clinical findings alone.
STROKE CLASSIFICATION:
-TACS ( total anterior circulation stroke)
- PACS (Partial anterior circulation stroke)
- LACS (Lacunar stroke)
- POCS ( Posterior circulation stroke)
61
TACS
A total anterior circulation stroke (TACS) is a large cortical stroke affecting the areas of the brain supplied by both the MIDDLE and ANTERIOR CEREBRAL arteries.
All three of the following need to be present for a diagnosis of a TACS:
- Unilateral weakness (and/or sensory deficit) of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
TACS has the highest mortality
62
PACS
A partial anterior circulation stroke (PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised.
Two of the following need to be present for a diagnosis of a PACS:
- Unilateral weakness (and/or sensory deficit) of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)*
*Higher cerebral dysfunction alone is also classified as PACS.
63
POSTERIOR CIRCULATION SYNDROME (POCS)
Posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).
One of the following need to be present for a diagnosis of a POCS:
-Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder (e.g. horizontal gaze palsy)
-Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
-Isolated homonymous hemianopia
64
LACUNAR STROKE
Lacunar stroke is a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked.
A lacunar stroke (LACS) is a subcortical stroke that occurs secondary to small vessel disease.
There is no loss of higher cerebral functions (e.g. dysphasia).
One of the following needs to be present for a diagnosis of a LACS:
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis
65
66
INTIALLY WHEN TREATING STROKE WHAT ARE THE GOALS?
- preservation of brain tissue
-restoration of blood flow
- prevention of recurrent stroke
67
THROMBOLYISIS and THROMBECTOMY
- THROMBOLYSIS with a Alteplase is considered once haemorrhage is excluded (after the CT scan).
- Alteplase is a tissue plasminogen activator that rapidly breaks down clots.
- It may be given within 4.5 hours of the symptom onset, based on local protocols and by an appropriately trained team.
- Patients need close monitoring for complications, particularly intracranial or systemic haemorrhage, with access to immediate imaging if bleeding is suspected.
- THROMBECTOMY is a surgery to remove a blood clot from a blood vessel (artery or vein).
- Thrombectomy is considered in patients with a confirmed blockage of the proximal anterior circulation or proximal posterior circulation. It may be considered within 24 hours of the symptom onset and alongside IV thrombolysis.
68
Blood Pressure and Haemorrhagic stroke
Blood pressure is aggressively treated in patients with a haemorrhagic stroke.
69
Blood Pressure and Ischaemic stroke
- In patients with an ischaemic stroke, lowering the blood pressure can worsen the ischaemia.
- High blood pressure treatment is only indicated in hypertensive emergency or to reduce the risks when giving intravenous thrombolysis.
70
71
72
73
74
75
76
77
78
79
STROKE
A stroke occurs when part of the brain loses its blood supply.
About 80% of strokes are from a clot blocking an artery (ischaemic stroke), and 20% from an artery bursting (haemorrhagic stroke)
80
STROKE
Stroke is also called cerebrovascular accident (CVA). Cerebrovascular accidents are either:
- Ischaemia or infarction of the brain tissue secondary to a disrupted blood supply (ischaemic stroke)
- Intracranial haemorrhage, with bleeding in or around the brain (haemorrhagic stroke)
81
ISCHAEMIA to INFARCTION
Ischaemia refers to an inadequate blood supply. Infarction refers to tissue death due to ischaemia.
82
ISHAEMIA
is a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body.
83
INFARCTION
infarction, death of tissue resulting from a failure of blood supply, commonly due to obstruction of a blood vessel by a blood clot or narrowing of the blood-vessel channel. The dead tissue is called an infarct.
84
SHOCK
- Shock is the body's response to a sudden drop in blood pressure.
-At first, the body responds to this life-threatening situation by constricting (narrowing) blood vessels in the extremities (hands and feet).
-This is called vasoconstriction and it helps conserve blood flow to the vital organs.
85
What causes the blood supply to the brain to be distrupted?
-A thrombus or embolus
-Atherosclerosis - arteries narrow
-Shock - a drop in blood pressure
- Vasculitis
86
TIA: Transient ischaemic attack
- Transient ischaemic attack (TIA) involves temporary neurological dysfunction (lasting less than 24 hours) caused by ischaemia but without infarction.
- Symptoms have a rapid onset and often resolve before the patient is seen.
- TIAs may precede a stroke.
- Crescendo TIAs are two or more TIAs within a week and indicate a high risk of stroke.
87
How to diffrentiaate between TIA and a STROKE?
When symptoms resolve in under 24 hours, this is a transient ischaemic attack (TIA).
88
STROKE SYMPTOMS
Common symptoms of a stroke include your face dropping on 1 side, not being able to lift your arms and slurred speech.
Stroke symptoms are typically asymmetrical. Common symptoms are:
- Limb weakness
- Facial weakness
-Dysphasia (speech disturbance)
-Visual field defects
-Sensory loss
-Ataxia and vertigo (posterior circulation infarction)
89
RISK FACTORS FOR STROKE
Previous stroke or TIA
Atrial fibrillation
Carotid artery stenosis
Hypertension
Diabetes
Raised cholesterol
Family history
Smoking
Obesity
Vasculitis
Thrombophilia
COMBINED CONTRACEPTIVE PILL
90
FAST TOOL
The FAST tool is used as a simple way to identify stroke in the community:
F – Face (Can the person smile? Has their mouth or eye drooped?)
A – Arm (Can the person raise their arms?)
S – Speech (Can the person speak clearly and understand what you say?)
T – Time (act fast and call 999)
Common symptoms of stroke:
- Sudden weakness or numbness on one side of the body, including legs, hands or feet.
- Difficulty finding words or speaking in clear sentences.
- Sudden blurred vision or loss of sight in one or both eyes.
- Sudden memory loss or confusion, and dizziness or a sudden fall.
- A sudden, severe headache.
91
MANAGEMENT OF TIA
Symptoms should have completely resolved within 24 hours of onset. Initial management involves:
-Aspirin 300mg daily (started immediately)
-Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
-Diffusion-weighted MRI scan is the imaging investigation of choice.
92
MANAGEMENT OF STROKE
The information here is summarised from the NICE guidelines (updated 2022) on stroke. Initial management involves:
-Exclude hypoglycaemia
-Immediate CT brain to exclude haemorrhage. Ischaemic stroke on CT Head can be normal; the purpose of a CT is to rule out haemorrhagic stroke.
-Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
-Admission to a specialist stroke centre
93
HEMORAHAGIC STROKE
- Haemorrhagic stroke is a cerebrovascular event that occurs when the wall of a blood vessel in the brain weakens and ruptures.
- This rupture causes bleeding in the brain (intercranial bleeding), leading to haematoma formation, and, consequently, neuronal injury.
- Approximately 15% of all stroke cases are attributed to haemorrhagic stroke, with the majority being ischaemic strokes (85%).
- Of these haemorrhagic strokes - 2 subtypes: three-quarters are intracerebral haemorrhages and the rest are subarachnoid haemorrhages.
94
INTRACEREBRAL HAEMMORRHAGES
Intracerebral haemorrhage involves bleeding within the brain secondary to a ruptured blood vessel.
Intracerebral haemorrhages can be intraparenchymal (within the brain tissue) and/or intraventricular (within the ventricles).
95
SUBARACHANOID HAEMORRAHGES
Subarachnoid haemorrhage is a type of stroke caused by bleeding outside of the brain tissue, between the pia mater and arachnoid mater.
96
INVESTIGATING
Neuroimaging:
- Computed tomography (CT) scan can quickly identify haemorrhage and is typically the first-line investigation.
- Magnetic resonance imaging (MRI) can provide more detailed images and help identify underlying causes.
- MR Angiogram or Digital Substraction Angiography can help identify any vascular abnormalities that may have caused the haemorrhage.
Blood tests: Full blood count, coagulation screen, electrolytes, liver function tests, cholesterol level, and glucose level.
Blood pressure control is a key aspect of management in the acute phase, with a target blood pressure of <140/80 mm Hg associated with better long-term outcomes.
97
SIGNS AND SYMPTOMS OF HAEMORRHAGIC STROKE
Severe headache
Altered consciousness, ranging from drowsiness to coma
Vomiting
Nuchal rigidity
Focal neurologic signs
Seizures
Hypertension
98
RISK FACTORS FOR HAEMMORHAGIC STROKES
Strong risk factors for haemorrhagic stroke include:
Age
Male sex
Family history of haemorrhagic stroke
Haemophilia
Cerebral amyloid angiopathy/hypertension
Anticoagulation therapy
Illicit sympathomimetic drugs (such as cocaine and amphetamines)
Vascular malformations (particularly in younger patients)
99
ISCHAEMIC STROKES
A stroke describes a sudden onset focal neurological deficit of vascular aetiology, with symptoms lasting >24 hours (or with evidence of infarction on imaging).
100
ALTEPLASE
Alteplase (tissue plasminogen activator) is indicated in patients presenting within 4.5 hours of symptom onset and with no contraindications to thrombolysis (e.g. recent head trauma, GI or intracranial haemorrhage, recent surgery, acceptable BP, platelet count, and INR).
101
HAEMOPHILLIA
A medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury.
The condition is typically caused by a hereditary lack of a coagulation factor, most often factor VIII
HAEMOPHILLIA A - deficinet in factor 8
HAEMOPHILLIA B - deficient in factor 9
102
VASCULAR AUTOREGUALTION
103
TRAUMATIC BRAIN INJURY
104
PRIMARY INJURIES
105
106
INTERCRANIAL BLEEDS
-Extradural haemorrhage (bleeding between the skull and dura mater)
-Subdural haemorrhage (bleeding between the dura mater and arachnoid mater)
-Intracerebral haemorrhage (bleeding into brain tissue)
-Subarachnoid haemorrhage (bleeding in the subarachnoid space)
107
EXTRADURAL HAEMORRHAGE and SUBDURAL HAEMATOMA
- Extradural haemorrhage occurs between the skull and dura mater and is usually caused by a rupture of the MIDDLE MENINGEAL ARTERY in the temporoparietal region.
- It can be associated with a fracture of the temporal bone. On a CT scan, they have a bi-convex shape and are limited by the cranial sutures (they do not cross the sutures, which are the points where the skull bones join together).
A typical history is a young patient with a traumatic head injury and an ongoing headache. They have a period of improved neurological symptoms and consciousness, followed by a rapid decline over hours as the haematoma gets large enough to compress the intracranial contents.
SUBDURAL HAEMOATOMMA:
- Subdural haemorrhage occurs between the dura mater and arachnoid mater and is caused by a rupture of the bridging veins in the outermost meningeal layer.
- On a CT scan, they have a crescent shape and are not limited by the cranial sutures (they can cross over the sutures).
- Subdural haemorrhages may occur in elderly and alcoholic patients, who have more atrophy in their brains, making the vessels more prone to rupture.
108
INTRACEREBRAL AND INTRAVENTRICULAR
109
SUBARACHNOID HAEMORRAHGE
Subarachnoid haemorrhage involves bleeding in the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane. This is usually the result of a ruptured cerebral aneurysm
COUP and COUNTERCOUP INJURIES
Contrecoup injuries classically occur when the moving head (brain) strikes a stationary object; whereas, a coup injury is associated with a moving object impacting a stationary head
110
PENETRATING HEAD INJURIES
111
112
CONCUSSION and DIFFUSE AXONAL INJURY
Concussion: is a mild traumatic brain injury (mTBI) that affects brain function. Effects are often short term and can include headaches and trouble with concentration, memory, balance, mood and sleep.
- Concussions usually are caused by an impact to the head or body that is associated with a change in brain function.
- CAUSE: falls, road crashes, assaults and sports accidents
CONCUSSION criteria:
- lose conciousness for less than 30 mins or not at all. Only 10% people who have a concussion lose consiousness
- Post-traumatic amnesia (PTA) of less than 24 hours after injury (this is a period where people are confused, act strangely and are unable to remember what has just happened)
DIFFUSE AXONAL INJURY:
- characterised by extensive, generalised damage to the white matter of the brain
Cause: rotational forces or sudden forceful stopping that stretches or tears the axon bundles
113
SECONDARY INJURY
114
RAISED INTRACRANIAL PRESSURE
115
CAUSES OF RAISED INTRACRANIAL PRESSURE
- Intercranial haemorrahge
- Tumours
- Brain odema
- Hydrocephalus
- Idiopathic
116
SYMPTOMS OF RAISED INTRACRANIAL PRESSURE
SYMPTOMS:
- headache
- vomiting
- papilledema
- The severity of a traumatic brain injury increases due to heightened ICP, especially if the pressure exceeds 40mmHg
- ICP monitoring involves placement of an invasive probe to measure the ICP.
117
BRAIN HERNIATION
- Brain herniation is the shifting of the brain tissue from one space in the skull to another through various folds and openings
- Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most often the result of brain swelling or bleeding from a head injury, stroke, or brain tumor.
Brain herniation can be a side effect of tumors in the brain, including:
-Metastatic brain tumor
- Primary brain tumor
Herniation of the brain can also be caused by other factors that lead to increased pressure inside the skull, including:
- Collection of pus and other material in the brain, usually from a bacterial or fungal infection (abscess)
- Bleeding in the brain (hemorrhage)
- Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
- Strokes that cause brain swelling
118
CLINICAL MANAGEMENT OF HEAD INJURY
- The glasgow coma scale is used to measure levels of consiousness
119
MANAGMENT OF MILD HEAD INJURY
120
121
122
123
124
HYPERTENSION
125
126
127
128
129
130
ATRIAL FIBRILATION
131
132
133
134
135
136
137
138
139
140
EPILEPSY
