Chapter 17: Head Trauma Flashcards
What is damaged in epidural hematoma?
Middle meningeal artery.
Classic presentation of epidural…
Lucid interval, followed by decline in level of consciousness with rapid progression to coma.
What herniates most often in epidural…
Uncus
CT of epidural
Biconvex hyperdense lesion between skull and dura
Cause of subdural?
Bridging veins tearing
Symptoms of subdural
HA is most common symptom with contralateral hemiparesis, seizures, and a wide variety of cortical dysfunction also common.
Subdural vs. Epidural
Subdural can cross suture lines
Chronic subdural population
Mild trauma in the elderly who are anticoagulated
Most common type of seizures that are posttraumatic
Tonic-clonic
What percent of posttraumatic develop epilepsy…
25%
Physical exam of central (transtentorial herniation)
Decrease in alertness followed by small, reactive pupils, due to disruption of sympathetic pathways from the hypothalamus.
Patient becomes decorticate, then decerebrate with fixed midposition pupils, then eventually death.
Uncal herniation physical exam
Ipsilateral third nerve palsy, followed by impairment of consciousness, then ipsilateral hemiplegia (compresses contralateral cerebral peduncle), may compress and stroke the PCA
Subalcine Herniation is
Cingulate gyrus herniating under the falx cerebri, may not affect the clinical picture b/c they are already fucked. Compression of ACA may result in leg weakness
Normal ICP
<15 mmHg
Normal Cerebral Perfusion Pressure (CPP)
60-75 mmHg
