Head Injury

Question 1

Head Injury

Answer 1

structural damage to head; synonymous with brain injury or traumatic brain injury (TBI)

2 types:
closed injuries and open wounds

Question 2

What are the main causes of head injury

Answer 2

Road accidents
Falls
Assaults

Question 3

Simple Skull fracture

Answer 3

linear break in the continuity of the bone

Question 4

Comminuated Skull Fracture

Answer 4

referes to a splintered or multiple fracture line

Question 5

Depressed Skull Fracture

Answer 5

when bone fragments are embedded into brain tissue

Question 6

Basilar Skull Fracture

Answer 6

fracture of the bones that form the base of the skull (brainstem/ behind then nose)

Question 7

Ethmoid cribriform plate Basilar Skull Fracture

Answer 7

most fragile portion of cranium (shattered in basilar skull fractures) and can result in leakage of CSF from nose or ear = infection of the meninges/brain

Damages CN I-III, VII and VIII or can result in intracranial bleeding

Question 8

Types of Primary/Direct Brain Injuries

Answer 8

Concussion
Contusion
Laceration

Question 9

Concussion

Answer 9

momentary interruption of brain function with or without loss of consciousness; recovery usually within 24 hrs.

Cannot be visualized/ only microscopic

Question 10

Post Concussion Syndrome

Answer 10

Headache, Irritability, Insomnia, Poor Concentration and memory for months

Question 11

Contusion

Answer 11

bruising of the brain
Can be visualized on CT
Often on rough irregular inner surface of brain
Typically frontal or temporal lobes = cognitive and motor deficits

Question 12

Laceration

Answer 12

Cut in the brain tissue/ tear in the brain tissue

Question 13

Types of Secondary Brain Injuries (damage results from the subsequent brain swelling)

Answer 13

Ischemia
Increased ICP
Cerebral Edema
Brain Herniation

**these are more serious than primary

Question 14

Focal Brain injuries

Answer 14

Contusion
Laceration
Hemorrhage

Question 15

Diffuse Brain Injuries

Answer 15

Concussion
Contusion (big one)
Shearing lesion (stretching and tearing of nerve cells as well as the blood vessels of the brain = Diffuse anxonal Injury
Hypoxic Brain injury

Question 16

Mild Brain Injury

Answer 16

momentary LOC without demonstrable neurologic symptoms or residual damage (except residual amnesia)

Microscopic changes detected in neurons and glia within hours of injury

Question 17

Moderate Brain Injury

Answer 17

Longer period of unconsciousness (that maybe infect speech and movement ex. hemiparesis, aphasia, and cranial nerve palsy)
Many small hemorrhages occur along with some swell in god the brain tissue

Question 18

Severe Brain Injury

Answer 18

Deep level of coma and the primary damage is instantaneous and irreversible d/t shearing and pressure forces (axonal injury)

Accompanied by neurologic deficits (hemiplagia) and occur with injuries to other parts of the body

Question 19

What are 3 locations for intracranial hemorrhage

Answer 19

Subdural hematoma (below the dura)
Intracerebral hematoma (within the brain tissue)
Epidural hematoma (outside of the dura)

Question 20

Coup

Answer 20

brain is thrown against one side of the skull in one continuous motion = damage immediately BELOW the site of impact

Question 21

Contre-coup

Answer 21

Brain rebounds and strikes the opposite side of the skull = injures regions in the brain OPPOSITE the side of impact

Question 22

Coup-Contrecoup

Answer 22

2 areas of damage
When brain strikes rough surface of cranial vault –> blood vessels, nerve tracts, and other structures are bruised an torn

Question 23

Hematoma

Answer 23

vascular injury/bleeding which can occur in several compartments:
epidural, subdural, subarachnoid space, intracerebral

Question 24

Epidural Hematoma

Answer 24

develops btwn the inner table of the bones of the skull and the dura and often d/t a tear in an artery r/t head injury/fracture

More common in young b/c dura is not as firmly attached to the skull/easily stripped away allowing hematoma to form

Most often the Meningeal Artery (located under the thin temporal bone)

Question 25

What are some symptoms r/t epidural hematoma

Answer 25

ipsilateral pupil dilation

contralateral hemiparesis

Question 26

Progression of an epidural hematoma

Answer 26

brief period of unconsciousness—>followed by a lucid period or regained consciousness –> followed by rapid progression to unconsciousness

**lucid does not always occur

Question 27

What happens if the epidural hematoma is not removed?

Answer 27

increased ICP = tentorial herniation (protrusion through an unnatural opening) = DEATH

Question 28

Subdural Hematoma

Answer 28

develops btwn dura and arachnoid space (subdural) d/t a tear in the small bridging veins that connect the veins to the surface of the cortex r/t “snapped” head injury/sudden movement of brain in relation to cranium

Question 29

Does subdural hematoma develop more rapid or more slow than epidural hematoma

Answer 29

more slowly because it is a tear in the venous system.

Question 30

Do Acute Subdural hematoma’s have a high mortality rate? If so why?

Answer 30

yes d/t the severity of secondary injuries r/t increased ICP, LOC, decerebrate posturing, delay in surgical removal of the hematoma

Question 31

The Subdural hematoma lacks a _____ period

Answer 31

lucid

Question 32

Chronic subdural hematoma

Answer 32

develops weeks after the head injury; blood seeps into the subdural space slowly, and is not absorbed, but becomes encapsulated = decrease LOC, drowsiness, confusion, headache

Question 33

Do chronic subdural hematoma’s have a high mortality rate?

Answer 33

Yes = higher than epidural and intracerebral hematoma mortality rates

Question 34

Intracerebral hematoma

Answer 34

bleeding occurs in the brain tissue itself (blood leaks into CSF) mainly in the frontal or temporal lobes

Question 35

Tx of Intracerebral hematomas

Answer 35

Surgical evacuation of clot

If stable, can observe and use gradual resolution

Question 36

What is a burr hole

Answer 36

hole drilled into the skull to release some pressure/vacuum out the hematoma (**part of the skull can be removed and stored in the abdomen in extreme cases)