Head Injury

Question 1

What are the four classifications of head injury?

Answer 1

Open
Closed
Focal
Diffuse

Question 2

Give some different pathological tyoes of head injury

Answer 2

Skull fractures
Lacerations to scalp
Cerebral concussion
Cerebral contusion
EDHaematoma
SDHaematoma
SAHaemorrhage
Intracerebral haematoma
Intraventricular haematoma
DAI

Question 3

What term describes skull fractures where part(s) of the cranium have been displaced inwards into the head?

Answer 3

Depressed

Question 4

Describe cerebral concussion

Answer 4

The mildest form of cerebral injury
Due to rotational acceleration of the head
Transient LOC followed by rapid return to normal

Question 5

Describe cerebral contusion

Answer 5

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

Question 6

What is an extradural haematoma?

Answer 6

Tearing of dural or skull vessels causing a build up of blood, usually as a result of fracture

Question 7

What age g4roup is most commonly affected by extradural haematoma?

Answer 7

Under 50s

Question 8

The rupture of which vessels accounts for 50% of extradural haematomas? What injury commonly accompanies this?

Answer 8

The middle meningeal vessels. Fractures, commonly of or around the pterion

Question 9

What is the classic sign of extradural haematoma?

Answer 9

LUCID INTERVAL - and initial loss of consciousness followed by recovery and then rapid deterioration

Question 10

What is a subdural haematoma?

Answer 10

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

Question 11

Describe chronic SDHaematoma

Answer 11

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

Question 12

Describe intracerebral haematoma

Answer 12

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

Question 13

Describe traumatic SAH

Answer 13

Results from significant insult to the brain

May lead to vasospasm as in aneurysmal SAH

Question 14

Describe intraventricular haemorrhage

Answer 14

A sign of severe head injury

May be primary or secondary to intracerebral haemorrhage

Question 15

What is the difference between haemorrhage and haematoma?

Answer 15

Haemorrhage refers to aloss of blood from the circulatory system
Haematoma is a localised collection of blood outside the vessels

Question 16

What causes primary intraventricular haemorrhage?

Answer 16

Tearing of a subependymal vein

Question 17

Describe DAI

Answer 17

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

Question 18

Describe the primary survey (ATLS)

Answer 18

A airway and cervical spine protection
B breathing with adequate circulation
C circulation and haemorrhage control
D disability
E exposure and environmental control

Question 19

What is the secondary survey (ATLS)?

Answer 19

Complete head to toe examination

Question 20

How can the neurological condition be assessed?

Answer 20

GCS

Pupillary response and size

Question 21

What are some general signs and symptoms of head injury?

Answer 21

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

Question 22

What are the basic Ix for suspected head injury?

Answer 22

Plain Xrays
CT
MRI

Question 23

What are the management principles for a patient with a head injury?

Answer 23

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

Question 24

What are some invasive management options in head injury patients?

Answer 24

Surgical -
Insertion of ICP bolt
Elevation of skull fractures
Evacuation of intracranial haematoma
Insertion of ventricular drains

Question 25

Give some potential complications in head injury patients

Answer 25

Ischaemia/infarct
Uncal herniation - death likely
Infections
Post-traumatic seizures
Hydrocephalus
Post concussion syndromes
Cranial nerve deficits
CSF leak - Rhinorrhoea/Otorrhoea