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Neuro > Head injuries > Flashcards

Head injuries Flashcards

1
Q

Describe primary and secondary classification of head injuries

A

Primary - immediately after injury

Secondary - at least hours after injury

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2
Q

Types of primary HIs and subtypes

A

Focal: haematoma or contusion
Diffuse: concussion or diffuse axonal injury

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3
Q

Types of haematoma

A

Extradural
Subdural
Intracerebral

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4
Q

Types of contusion

A

Coup at side of impact

Contrecoup at opposite side of impact

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5
Q

Describe diffuse axonal injury and what it can lead to

A

Shearing of interface between grey and white matter following acceleration-deceleration to the brain damaging the intracerebral axons and dendritic connections
Cerebral oedema which increases ICP

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6
Q

Describe contusion

A

Trauma to head causes blood to mix with cortical tissue due to micro haemorrhages
Damage leads to oedema or IC haemorrhage which can cause coma or death

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7
Q

Definition of concussion

A

Head injury with loss of brain function caused by stretching of axons (impaired neurotransmission, loss of ion regulation, decreased cerebral blood flow)

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8
Q

Describe traumatic and non traumatic classification of head injuries

A

Traumatic: open or closed

Non-traumatic e.g CVA, tumour, infection, anoxia

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9
Q

Signs of basilar skull fractures

A

CSF rhinorrhoea due to meningeal tears
Raccoon eyes
Battle sign
Haemotympanum

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10
Q

Criteria for urgent CT head with HIs

A

GCS <13 or GCS <14 >2 hrs after injury
Suspected open, depressed or base of skull fracture
Focal deficit
Seizure
Loss of consciousness WITH age >65 or coagulopathy

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11
Q

Where does blood collect in an extradural haemorrhage

A

Between the inner skull and periosteal dura mater

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12
Q

Which artery is most commonly severed in an EDH and why

A

Middle meningeal artery (anterior branch?)

Runs behind pterion which is weakest part of skull

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13
Q

In what age groups are EDH more common and why

A

<20 because with increasing age the dura sticks more firmly to the skull

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14
Q

Describe the events that occur after an EDH

A

LOC from injury
Lucid interval
Rapid decline in consciousness as haematoma enlarges
Herniation

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15
Q

CT head features in EDH

A

Biconvex haematoma
Midline shift
Ventricle compression

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16
Q

What limits shape of haematoma in EDH

A

Suture lines

17
Q

Different management for small and large EDH

A

Small: observe for few hours, neuro follow up

Large: craniotomy, clot evacuation

18
Q

Complications of EDH

A 
Brain damage
Coma
Seizure
Weakness
AV fistula
19
Q

Where does blood collect in a subdural haemorrhage

A

Between the arachnoid and meningeal dura mater

20
Q

Types of SDH

A

Chronic: >3 weeks
Subacute: 3-21 days
Acute: <3 days

21
Q

Why does risk of SDH increase with age

A

Cerebral atrophy with age increases risk of rupture of the cortical bridging veins

22
Q

CT head features in SDH

A

Sickle shaped as doesn’t cross falx cerebri
Acute: white
Chronic: dark

23
Q

Management for SDH

A

Acute: relieve ICP, neurosurgery
Symptomatic chronic: burrholes
Small chronic: serial imaging

24
Q

What worsens prognosis of SDH

A

Need surgery

On anticoagulants

25
Q

Where does blood collect in a subarachnoid damage

A

Between pia and arachnoid mater

26
Q

Symptoms of SAH

A 
Thunderclap headache
Meningism 
Nausea and vomiting
Focal neurological deficits
Loss of consciousness
27
Q

Cause of SAH

A

Berry aneurysm rupture (at points of bifurcation in the anterior circulation)

28
Q

CT head features of SAH

A

Spider like shape of hyperdensity due to blood (appears bright) in arachnoid

29
Q

Diagnosis of SAH

A

LP to rule out meningitis and look for RBCs and xanthochromia (if no signs of raised ICP)

30
Q

Management of SAH

A 
Stabilise patient
Prevent rebleeding
Give Ca channel blockers to treat cerebral vasospasms
Correct hyponatraemia 
Neurosurgical intervention if large
31
Q

Mortality rate of SAH

A

30-90%

32
Q

What worsens prognosis of SAH

A

Worse GCS

Worse neurological deficit

33
Q

Complications of SAH

A 
Hydrocephalus - blood in SA space which prevents CSF absorption 
Focal neurological deficit
Coma
Seizures
Headaches 
Decline in cognitive function
Hypopituitarism
34
Q

How to read CT head

A 
Intracranial or intracerebral
Shape
Density - dark means ischaemia or oedema, bright means blood
Cerebral oedema
Ventricles 
Midline shift
35
Q

Risk factors for berry aneurysm

A 
Smoking
Alcohol
Hypertension
Family history
Autosomal dominant polycystic kidney disease

Neuro (19 decks)

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