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Neurosurgery Basics > Ch. 4 - Head injuries > Flashcards

Ch. 4 - Head injuries Flashcards

1
Q

Minimum criteria for concussion (according to text)

A

Period of amnesia

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2
Q

Which CN is easily damaged by torsion or herniation of brain?

A

CN6 - causes diplopia 2/2 unopposed action of medial rectus muscle

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3
Q

GCS score indicating severe brain injury

A

8 or less

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4
Q

Decerebrate posturing

A

Upper limbs adducted and internally rotated but extended at elbow; suggests upper brainstem injury

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5
Q

Indications for CT

A
  • loss of consciousness >10 min
  • persistent drowsiness
  • persistent nausea
  • lateralizing neurologic signs
  • skull fracture
  • CSF rhinorrhea
  • injuries necessitating ventilation
  • ALWAYS get plain film or CT of cervical spine
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6
Q

How long should you observe person with a head injury?

A

At least 4 hours

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7
Q

Why control temperature after head injury?

A

Elevated temps can increase ICP

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8
Q

If concerned about increased ICP, what is PaCO2 goal?

A

PaCO2 of 30-35

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9
Q

Signs of anterior fossa fracture

A

Subconjunctival hemorrhage extending to posterior limits of sclera (raccoon eyes are just subgaleal), anosmia, nasal tip parasthesia

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10
Q

Describe a ‘contre-coup’ injury

A

Sudden acceleration/deceleration force resulting in opposite ‘poles’ of brain being jammed against cranial vault

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11
Q

A concussion is regarded as being severe when the amnesia following the head injury lasts how long?

A

More than 1 day

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12
Q

Causes of traumatic mydriasis

A

Uncal herniation OR direct trauma

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13
Q

Describe difference between simple, depressed, and compound skull fractures

A

Simple – linear fracture of vault
Depressed – bone fragments depressed beneath vault
Compound – direct communication with external environment

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14
Q

What is the first sign of a depressed conscious state?

A

DROWSINESS

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15
Q

What does the term ‘coma’ refer to?

A

Patient who shows no response to external stimuli, does not obey commands, is unable to utter comprehensible words, and does not open eyes

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16
Q

With frontal lobe lesion, gaze will deviate to which side?

A

Ipsilateral to side of lesion

17
Q

With pontine lesion, gaze will deviate to which side?

A

Contralateral to side of lesion

18
Q

GCS parameters

A

Eye opening, best verbal response, best motor response to painful stimulus

19
Q

Decorticate posturing

A

Upper limbs adducted and internally rotated and flexed at elbow; suggests cerebral white matter and basal ganglia injury

20
Q

Pyrexia is common after head injury. What does pyrexia lasting >2 days suggest?

A

Traumatic subarachnoid hemorrhage or severe brainstem injury

21
Q

What electrolyte abnormalities can be expected after head trauma?

A

Retention of sodium and water leading to mild hyponatremia + excretion of potassium

22
Q

Most common sites of infection after head injury

A

Respiratory and urinary tracts!

23
Q

What should cerebral perfusion pressure be maintained at?

A

Above 70 mmHg

24
Q

What is the risk of epilepsy following a depressed skull fracture?

A

15%; continue prophylactic anticonvulsant medication for 1 year if dura was penetrated

25
Q

Signs of middle fossa fracture involving petrous temporal bone

A

CSF otorrhea (or rhinorrhea) via Eustachian tube, deafness 2/2 CN8 or ossicular injury, hemotympanum, Battle’s sign (bruising over mastoid bone), CN7 palsy

26
Q

Major concern of dural fistula

A

Infection; tx possible fistula with prophylactic abx (penicillin to cover Streptococcus - most common organism)

27
Q

Indications for surgery in anterior cranial fossa injuries and possible dural fistula

A
  • CSF leakage >5 days
  • intracranial aerocele
  • episode of meningitis
28
Q

Describe tangential vs. penetrating vs. through-and-through missile injuries

A

Tangential - does not enter cranium but causes depressed skull fracture
Penetrating - enters cranium resulting in deposition within brain
Through-and-through - enters and exits cranium

29
Q

Doubles mortality in TBI

A

Hypotension or hypoxia

Neurosurgery Basics (21 decks)

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