Head injury

Question 1

What causes secondary brain injury?

Answer 1

Loss of blood-brain-barrier: leucocyte infiltration/inflammation

Loss of cerebral autoregulation of blood pressure - ischaemia

Loss of cerebral autoregulation of blood flow:even more ischaemia causing further brain oedema

Question 3

What is the monro-Kellie hypothesis?

Answer 3

The skull is an inelastic closed box of constant volume

This volume consists of brain, circulating blood and CSF

An increase in volume of one component must produce a decrease in another component otherwise the ICP will rise

Question 4

What makes up cerebral perfusion pressure?

Answer 4

Cerebral perfusion pressure = mean arterial pressure – intracranial pressure

Question 5

What is the target cerebral perfusion pressure following head injury?

Answer 5

>60mmHg

Question 6

What two types of head injury are there?

Answer 6

Open/penetration

Closed/acceleration-deceleration

Question 7

What are the signs of an anterior cranial fossa base of skull fracture?

Answer 7

Sunken/panda eyes

Question 8

What sign indicates a middle cranial fossa base of skull fracture?

Answer 8

Battles sign

Question 9

What types of herniation might occur in the brain

Answer 9

Question 10

What is the definition of a coma?

Answer 10

Doesn’t open eyes

Doesn’t obey commands

Doesn’t speak

Equates to a GCS of 8 or less

Question 11

How is Glasgow coma score assessed?

Answer 11

Eye opening:

spontaneously

to command

to pain

none

Verbal response:

orientated

confused

inappropriate words

incomprehensible sounds

none

Best motor response:

obeys commands

localises pain

flexes to pain

abnormal flexion

extension

none

Question 12

What types of brain haemorrhage are there (outer to inner)?

Answer 12

Extradural haematoma

Subdural haematoma

Traumatic subarachnoid haemorrhage

Intracerebral contusion

Intracerebral haematoma

Intraventricular haemorrhage

Question 13

What type of brain haemorrhage is this?

Answer 13

Extradural haematoma

Question 14

What type of brain haemorrhage is this?

Answer 14

Extradural haematoma

Question 15

What brain haemorrhages are present here?

Answer 15

Subdural haematoma

Intracerebral haematoma

Question 16

What type of haemorrhage is present here?

Answer 16

Subdural haematoma

Question 17

What type of brain haemorrhage is this?

Answer 17

Subarachnoid haemorrhage

Question 18

What drug can be used to protect cerebrum following injury?

Answer 18

Mannitol

Question 19

What is post-concussion syndrome?

Answer 19

A set of symptoms that may continue for weeks, months, or a year or more after a concussion

Includes: poor concentration, headache, poor memory lethargy

Question 20

What is the most common type of traumatic brain injury?

Answer 20

Concussion

Question 21

What are the signs and symptoms of concussion?

Answer 21

Headache

Nausea/vomiting

Dizziness

Difficulty balancing

Lack of motor coordination

Light sensitivity

Question 22

What parts of the brain are most affected by rotational forces?

Answer 22

Midbrain and diencephalon

Question 23

What are the red flag signs and symptoms for potentially serious brain injury?

Answer 23

Seizure

Worsening headache

Difficulty waking up

Seeing double

Problem recognizing people or places

Repeated vomiting

Focal neurological problems

Not usual self

Unequal pupil size