Brain Trauma Flashcards
X rays
Pros
- Fast
- Limited
- Good - bones + FBs
- Cheap
X rays
Cons
- Virtually no information about soft tissues
- Must be done in multiple planes
- almost no acute management = Head trauma
CTs
Pros
- Fast
- few contraindications (Preg, peds = but high Radio)
- all 3 planes
- Good = bones, blood, FBs
CTs
Cons
- VERY HIGH radiation
* Bad = soft tissue (MRI better)
MRI
Pros
- good - soft tissue/ligaments, brain/spinal
* no radiation
MRI
Cons
Slow, expensive
Contraindications (stent)
*Low use in acute ettign
Traumatic Brain Injury
Death risks
- Older = Falls
- Self-harm = middle age
- MVC = young
- Assault = infant
Injury w/
- consciousness loss
- memory loss - events preceding accident
- mental status altering
- focal neuro s/s
Mild TBI
= Mild TBI
- transient LOC
- lightheadedness
- n/V
- vision
- cognitive/ memory
Concussion
TBI
Initial management
- triage
- +/- trauma team
- Image (CT w/o contrast)
- Labs: CBC, BMP, Coags (PT etc.), UA/Utox
- Neurosurgical consult
Initial Neuro exam
- Inspect cranium
- Cranio-cervical junction
- Seizure
- Alertness
- CN exam
- Motor exam
- Sensory exam
- Reflexes
Assess consciousness?
Glasgow Coma Scale
Assess concussion?
Possible eval tool = ACE (acute concussion evaluation) , MANY OTHERS POSSIBLE
Concussion management
*REST
*return to play once symptoms have resolved
(7-14 days, possibly weeks to months)
-FOLLOW LOCAL TOOL for stepwise play activity assessment (must complete step w/o symptoms for 24 hours) = VERY LETIGIOUS
*Managing these S/S = REFER TO NEURO
Concussion lasting 3 months + ?
Post-concussive syndrome
- Refer to neuro
- Delayed hydrocephalus? Post traumatic seizures?
S/s w/
- Severe headache
- Vomiting
- Age >60
- Intoxication
- Amnesia
- Post-traumatic seizure
- Blood thinners
- PE - trauma above clavicle
????
RED FLAG - SCAN NOW
Activate Trauma team
(Especially - Intoxication + bruise + confusion)
CT rules out
Blood Hydrocephalus Cerebral swelling Skull fracture Pneumocephalus Midline shift
- acute/subacute/trauma
- distant trauma Hx
- size, midline shift, GCS, location
SAH
*size, midline shift, GCS, location
*ANY SIGN? = REFER TO NEURO OR
CT findings
- Acute blood =WHITE
- crescent shaped/ concave
- +/- Mass Effect
- +/- Midline shift
Subdural Hematoma
*Head injury w/ brief traumatic LOC–> Lucid Interval–> Deterioration –>Coma
Epidural Hematoma
- Less common than Subdurals
- Middle meningial arterial bleeding
CT
Acute blood white Biconvex shape (egg) next to skull
Epidural Hematoma
CT
Subdural vs. Epidural Hematoma
Subdural = crescent shape
Epidural = balloon shape
Epidural hematoma
Management
- surgery
* can herniate quickly!
5 forms of herniation
Central (transtentorial)
Uncal
Cingulate/subfalcine
Upward cerebellar
Tonsillar
- altered mental status
- respiration, oculomotor motor problems
Diencephalon through tentorial incisura
Shear pituitary stalk - DK
Central Herniation
*trapped PCA’s/pca strokes = cortical blindness
- Dilated Pupil
- contralateral weakness
- rapid expanding traumatic hematomas = push uncus + hipoccampus OVER tentorium
Uncal Herniation
- 3rd nerve
- Midbrain compression - contra weakness
- gunshot wounds - most lethal
* soft tissue/skull factors
Penetrating trauma
*bacteria dragged in
Craniectomy vs Craniotomy
- otomy = skull bone put back
- ectomy = no bone put back
Penetrating trauma workup
Image
Cerebral angiogram
- bleeding into Subarachnoid layer
- usually small vessels
- severe TBI s/s
SubArach Hemorrhage - Trauma
- seizure prophylaxis
- not operable
Intracerebral hemorrhage/ Cerebral contusion
- Trauma
- w/ tSAH
- have to do mutliple CTs to see
- not operative
CTs = how often
Every 6 hours
*decline in memory/executive function
*Mood/behavior change
*eventual dementia
AFTER REPEATED TRAUMA
Chronic Traumatic Encephalopathy
- DX ONLY post-mortem
- s/s usually decades after trauma (40-50 y/o)
Danger!!!!
Head trauma w/
*BLOOD THINNER
(Aspirin, Coumadin, Eliquis, Pradaxa)
- Intoxicated (DRUNK)
- unexplainable abnormal exam finding
“He’s just drunk”
- Liver disease –> clotting factors
* S/s drunk SAME as TBI
