Head Injury

Question 1

How do you calculate cerebral perfusion pressure?

Answer 1

CPP = Mean Arterial Pressure - Intracranial pressure

Aim for CPP of >60mmHg after a head injury

Normal adult ICP is 9-11 mmHg

Question 2

Clinical finding in middle cranial fossa fracture?

Answer 2

“battle sign” over mastoid area

Question 3

Clinical finding in anterior cranial fossa fracture?

Answer 3

Racoon eyes / Panda eyes

Question 4

Focal signs in head injury, eyes?

Answer 4

Abnormal pupillary responses to light could indicate a 3rd nerve palsy.

Question 5

Definition of a coma equates to a GCS score of what?

Answer 5

8 or less.

Question 6

When should you request a CT head in a head injury patient?

Answer 6

• Any patient with a GCS < 15.
• Any patient taking anti coagulants.
• Anyone with focal neurological signs.
• Anyone with a suspected skull #

Question 7

What shape is an extradural haemorrhage on CT?

Answer 7

It is convex

Question 8

What shape is a subdural haemorrhage on CT?

Answer 8

It is concave

Question 9

What is the role of mannitol following a brain/head injury?

Answer 9

It helps to improve micro perfusion, it is a diuretic that is used to reduce swelling and pressure around the brain.

Hypertonic saline may be better than mannitol.

Question 10

subarachnoid haemorrhage presentation?

Answer 10

• Sudden onset severe headache
• Collapse
• Vomiting
• Neck pain
• Photophobia

Question 11

Ddx of a sudden onset headache?

Answer 11

• Benign coital cephalgia.
• SAH
• Migraine

Question 12

Lumbar puncture signs in SAH?

Answer 12

Bloodstained or xanthochromic CSF. (6-48hrs after event)

- Must differentiate from traumatic tap.

Question 13

What is the gold standard in SAH?

Answer 13

Cerebral angiography

Question 14

Hypertensive Intracererbral haemorrhage type of aneurysms?

Answer 14

Charcot Bouchard aneurysms arising in small perforating arteries.