head injury

Question 1

what are the local complications of skull fracture

Answer 1

meningeal artery tear (extradural haematoma), dural venous tear (subdural haematoma), CSF rhinorrhoea and otorrhoea

Question 2

what are the mechanisms of traumatic brain injury

Answer 2

diffuse axonal injury, neuronal and axonal damage from direct trauma, brain oedema and incr ICP, brain hypoxia, brain ischaemia

Question 3

what is diffuse axonal injury

Answer 3

shearing and rotational stresses on decelerating brain, sometimes at the site opposite the impact (contrecoup)

Question 4

what can severe TBI be defined as

Answer 4

post traumatic amnesia >24hours, GCS 5/15

Question 5

late sequelae of TBI

Answer 5

incomplete recovery- cognitive, hemiparesis; post traumatic epilepsy; post traumatic syndrome (dizzy, headache, malaise); BPPV; chronic subdural haematoma; hydrocephalus; chronic traumatic encephalopathy

Question 6

what is chronic traumatic encephalopathy

Answer 6

cognitive, extrapyramidal and pyramidal signs. ‘punch drunk’

Question 7

what happens in post traumatic epilepsy

Answer 7

depressed skull fracture, penetrating injury and intracranial haemorrhage increase risk. can happen up to a year after event. risk is not increased after mild injury

Question 8

long term problems in survivors

Answer 8

cognitive- amnesia, neglect, disordered attention, motivation. behavioural/emotional- temper dyscontrol, depression, grief reactions

Question 9

what is subdural haematoma

Answer 9

collection blood in subdural space following rupture of a vein. interval between injury and symptoms can be days- months

Question 10

when is spontaneous SDH common

Answer 10

in the elderly and occurs with anticoagulants

Question 11

symptoms/signs SDH

Answer 11

headache, drowsy, confusion, symptoms can fluctuate, focal deficits develop late (hemiparesis). increase ICP and seizures

Question 12

what does CT/MRI show in SDH

Answer 12

clot and midline shift. crescent shaped collection of blood over one hemisphere, sickle shape

Question 13

treat SDH

Answer 13

irrigation/evacuation via craniostomy. craniotomy is 2nd line. can resolve spontaneously

Question 14

differential SDH

Answer 14

stroke, dementia, CNS masses

Question 15

when does extra dural haemorrhage occur

Answer 15

typically after linear fracture, damage to middle meningeal artery (parietal or temporal bone). blood accumulates over mins-hours.

Question 16

what happens in EDH

Answer 16

brief LOC then LUCID INTERVAL. after this patient is stuporose, ipsilateral dilated pupil, contralat hemiparesis, coning.

Question 17

what happens later on to signs in EDH

Answer 17

bilat fixed dilated pupils, tetraplegia, resp arrest

Question 18

symptoms EDH

Answer 18

decr GCS by incr ICP. severe headache, vomiting, confusion, fits, +- hemiparesis with brisk reflexes upgoing plantars

Question 19

which type of brain bleed has a LUCID INTERVAL

Answer 19

extra dural haemorrhage

Question 20

what does the CT show in EDH

Answer 20

biconvex/lens shaped, rounded

Question 21

is LP contraindicated in EDH

Answer 21

YES

Question 22

management EDH

Answer 22

clot evacuation +- ligation bleeding bvessel. may require intubation and ventilation