Head injury

Question 1

When to CT?

Answer 1

Immediate CT scan if GCS < 13 on arrival or < 15 2 hours post injury
Any sign of skull fracture, seizure, neurological deficits or > 1 vomiting.

Within 8 hours if > 65years, history of bleeding/clotting, on warfarin, dangerous mechanism, > 30 minutes retrograde amnesia pre incident

Question 2

What is an extradural haematoma?

Answer 2

Bleeding in-between dura mater and skull. Commonly temporal region due to rupture of middle meningeal artery.

Features: raised ICP, lucid interval.

Question 3

Subdural haematoma?

Answer 3

Bleeding into outermost meningeal layer. Frontal/parietal layer.
Acute due to trauma or chronic due to old age and alcoholism. Rupture of bridging veins causes slow bleeding.
Slower symptoms, fluctuating consciousness.

Question 4

Subarachnoid haemorrhage?

Answer 4

Spontaneously ruptured cerebral aneurysm +/- trauma.
Thunderclap headache. Meningism.
Spontaneous causes: Berry aneurysm, AV malformation, arterial dissection

Question 5

Management

Answer 5

Life threatening rising ICP- IV mannitol.

Decompressive craniotomy + evacuation of haematoma, Burr Holes

Question 6

Intracerebral haematoma

Answer 6

Causes: hypertension, vascular lesion e.g. malformation or aneurysm, trauma, tumour, infarct in stroke patients undergoing thrombolysis (CT- hyperdense bright lesion)