Cerebral Injuries

Question 1

etiology of head injuries in infants

Answer 1

• falls and child abuse

Question 2

etiology of head injury in children under 2

Answer 2

• falls

Question 3

etiology of head injuries in preschool/school age children

Answer 3

• auto accidents

Question 4

etiology of head injuries in older children and adolescents

Answer 4

• accidents involving motor vehicles, cycles, and sports injuries
• males outnumber females 2:1

Question 5

priority of assessment

Answer 5

• airway and stabilize neck

Question 6

primary cerebral injuries

Answer 6

• occur at time of trauma
  
  • skull injuries
  • contusion
  • intracranial hematomas
  • diffuse injuries

Question 7

secondary cerebral injuries

Answer 7

• what occurs because of the trauma
  
  • hypoxic brain damage
  • inc ICP
  • infection
  • cerebral edema

Question 8

neurological manifestations of a concussion

Answer 8

• impaired consciousness for a variable period of time
• HA: post concussion syndrome
• vertigo
• depressed reflexes
• anxiety
• general malaise

Question 9

respiratory manifestations of a concussion

Answer 9

• dec respirations

Question 10

cardiovascular manifestations of a concussion

Answer 10

• bradycardia
• hypotension

Question 11

post concussion syndrome

Answer 11

• symptom complex may occur within days of injury and can include:
  
  • HA
  • dizziness
  • fatigue
  • irritability
  • anxiety
  • insomnia
  • loss of consciousness
  • memory impairment
• clinical symptoms of the following are all closely related with post concussion syndrome:
  
  • posttraumatic amnesia
  • GCS <15
  • disorientation
  • change in mental status

Question 12

neurological manifestations of a head contusion and laceration

Answer 12

• possible loss of consciousness
• mild motor or sensory weakness
• HA
• vertigo
• post traumatic sz
• coma
• irritability
• restlessness

Question 13

neurological manifestations of fractures

Answer 13

• altered skull contour
• conjunctival hemorrhage–assoc with fxs of anterior fossa
• CSF rhinorrhea/otorrhea (out of nose/ears)
• periorbital ecchymosis
• palsies of C1, C7, C8 nerves
• post traumatic sz–late sign
• coma

Question 14

cardiovascular and integumentary manifestations of fractures

Answer 14

• hypovolemia: assoc with fxs over the lateral or sagittal sinus
• eccymosis of the base of the neck: assoc with basilar skull fx and fx over the mastoid process

Question 15

list the complications of head injuries

Answer 15

• epidural hematoma
• subdural hematoma
• subarachnoid hemorrhage
• intracerebral hemorrhage
• cerebral edema
• post traumatic syndrome
• sz

Question 16

epidural hematoma

Answer 16

• as the hematoma inc, the dura is stripped from the skull–>leads to forcing the underlying brain contents downward and inward as it expands
• occur infrequently in infants and children, but when they do, they are usually caused by child abuse (shaken baby) in the infant and child and MVCs in the adolescent
• usually arterial in origin–>leads to rapid brain decompression

Question 17

neuro manifestations of epidural hematoma

Answer 17

• momentary unconsciousness–>followed by a normal period for several hours, then lethargy or coma due to blood accumulation in the epidural space
  
  • lethargy and coma due to blood accumulation in epidural space and compression of brain
  • cushing’s triad is late sign of impending brain herniation

Question 18

resp, cardio, GI manifestations of epidural hematoma

Answer 18

• resp depression
• apnea
• bradycardia
• vomiting

Question 19

subdural hematoma

Answer 19

• bleeding b/w the dura and arachnoid matter
• more common than epidural hematomas in children
  
  • peak incidence at 6 mos of age
  • often due to child abuse–shaken baby

Question 20

neuro manifestations of subdural hematoma

Answer 20

• HA–>irritable, fussy
• loss of consciousness
• focal sz
• u/l pupillary dilation
• hemiparesis
• agitation
• drowsiness w/ confusion
• progressive slowing of thinking

Question 21

submersion injury

Answer 21

• major cause of unintentional injury–>related death in kids 1-4 yo
• most organ systems will be affected
• all children who have a submersion injury should be admitted for observation
  
  • b/c symptoms/complications may not show up for 24 hrs
• problems seen with submersion injury:
  
  • hypoxia and asphyxiation–>#1 priority!
  • aspiration
  • hypothermia