Head injury Flashcards
what is an extradural haematoma?
Bleeding into the space between the dura mater and the skull.
Often results from acceleration-deceleration trauma or a blow to the side of the head.
The majority of extradural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery.
features of extradural haematoma
Raised intracranial pressure
Some patients may exhibit a lucid interval
what is a subdural haematoma?
Bleeding into the outermost meningeal layer.
Most commonly occur around the frontal and parietal lobes.
May be either acute or chronic.
risk factors of subdural haematoma?
old age
alcoholism
onset of subdural haematoma in comparison to extradural haematoma
Slower onset of symptoms than a extradural haematoma.
what is a subarachnoid haemorrhage?
Usually occurs spontaneously in the context of a ruptured cerebral aneurysm, but may be seen in association with other injuries when a patient has sustained a traumatic brain injury.
when does a secondary brain injury occur?
cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation exacerbates the original injury.
what is the cushings effect
(hypertension and bradycardia) often occurs late and is usually a pre terminal event
Mx of life threatening rising of ICP such as in an extradural haematoma
whilst theatre is prepared or transfer arranged use of IV mannitol/ frusemide
Mx of diffuse cerebral oedema
decompressive craniotomy
how are open depressed skull fractures managed
formal reduction and debridement
how are closed depressed skull fractures managed
non-operatively
when is ICP monitoring appropriate?
GCS 3-8
Normal CT scan
when is ICP monitoring mandatory
GCS 3-8
abnormal CT scan
what is the minimum cerebral perfusion pressure in adults?
70 mmHg
