Head Injury Flashcards
What are the four classifications of head injury?
Open
Closed
Focal
Diffuse
Give some different pathological tyoes of head injury
Skull fractures Lacerations to scalp Cerebral concussion Cerebral contusion EDHaematoma SDHaematoma SAHaemorrhage Intracerebral haematoma Intraventricular haematoma DAI
What term describes skull fractures where part(s) of the cranium have been displaced inwards into the head?
Depressed
Describe cerebral concussion
The mildest form of cerebral injury
Due to rotational acceleration of the head
Transient LOC followed by rapid return to normal
Describe cerebral contusion
Extravasation (leakage) of blood and associated swelling
Brain may be necrotic, soft or haemorrhagic
Usually affects frontal and temporal poles
Coup and contrecoup type injuries
What is an extradural haematoma?
Tearing of dural or skull vessels causing a build up of blood, usually as a result of fracture
What age g4roup is most commonly affected by extradural haematoma?
Under 50s
The rupture of which vessels accounts for 50% of extradural haematomas? What injury commonly accompanies this?
The middle meningeal vessels. Fractures, commonly of or around the pterion
What is the classic sign of extradural haematoma?
LUCID INTERVAL - and initial loss of consciousness followed by recovery and then rapid deterioration
What is a subdural haematoma?
A build up of blood due to tearing of bridging veins between the cortex and the venous sinuses. May be acute, subacute or chronic and may be associated with existing damage. Leads to secondary brain damage and immediate evacuation is essential - blood is not ‘pouched’ by the dural folds as it is in an EDH
Describe chronic SDHaematoma
History of mild trauma, most commonly in the elderly
Gradual enlargement with resulting compression of the brain. Needs to be evacuated but not as urgent as an acute or subacute SDH
Describe intracerebral haematoma
Usually associated with lobar contusions that cause direct rupture of intrinsic cerebral vessels. May be single or multiple and there is an increased risk in those on anticoagulants
Describe traumatic SAH
Results from significant insult to the brain
May lead to vasospasm as in aneurysmal SAH
Describe intraventricular haemorrhage
A sign of severe head injury
May be primary or secondary to intracerebral haemorrhage
What is the difference between haemorrhage and haematoma?
Haemorrhage refers to aloss of blood from the circulatory system
Haematoma is a localised collection of blood outside the vessels
What causes primary intraventricular haemorrhage?
Tearing of a subependymal vein
Describe DAI
Results from more severe angular rotational acceleration - a ‘shearing’ injury causing mutliple minute haemorrhages
CT may not reveal haematoma
Causes axonal swelling and disruption as well as punctate haemorrhages
Severe DAI may lead to coma and severe neurological deficits, in some cases to persistent vegetative state
Describe the primary survey (ATLS)
A airway and cervical spine protection B breathing with adequate circulation C circulation and haemorrhage control D disability E exposure and environmental control
What is the secondary survey (ATLS)?
Complete head to toe examination
How can the neurological condition be assessed?
GCS
Pupillary response and size
What are some general signs and symptoms of head injury?
Loss of consciousness Drowsiness Vomiting Bleeding/watery discharge from nose or ear Seizures Headache Memory loss
May have bruising of scalp/face etc,
With OR WITHOUT neurological deficit
What are the basic Ix for suspected head injury?
Plain Xrays
CT
MRI
What are the management principles for a patient with a head injury?
Close monitoring
Intubation and ventilation - always when GCS below 8
ICP MANAGEMENT
Sedation, elevation of HOB, paralytics
CSF diversion, hypertonic saline, diuretics, hypothermia, barbiturate coma
What are some invasive management options in head injury patients?
Surgical - Insertion of ICP bolt Elevation of skull fractures Evacuation of intracranial haematoma Insertion of ventricular drains
Give some potential complications in head injury patients
Ischaemia/infarct Uncal herniation - death likely Infections Post-traumatic seizures Hydrocephalus Post concussion syndromes Cranial nerve deficits CSF leak - Rhinorrhoea/Otorrhoea
