Head Injury

Question 1

How can the sevirity of head injuries be classified and what test is helpful in classification?

Answer 1

• Mild (GCS > 12)
• Moderate (GCS 9-12)
• Severe

Question 2

What is GCS?

Answer 2

Glasgow coma scale
ranks from 3-15

Not a good clinical scale for measuring the milder head injuries

poor discriminator in paediatrics

Question 3

Describe a primary brain injury

Answer 3

= haemorrhage

Any time a blood vessel is broken and bleeding

Question 4

Why is a brain haemorrhage serious?

Answer 4

blood collecting inside the skull’s confined space creates pressure on delicate brain tissues potentially causing irreparable brain damage.

Question 5

How are brain haemorrhages managed?

Answer 5

In cases of brain haemorrhage, doctors will monitor the intracranial pressure and perform surgery to drain the fluid build-up if necessary.

Question 6

Describe a secondary brain injury

Answer 6

= haematoma

A collection of blood in the body’s tissues (e.g. bruise/contusion)

Question 7

How is internal bleeding categorised in head injuries?

Answer 7

Based on how deep in relation to the 3 layers of the meninges

• epidural hematoma
• subdural hematoma
• subarachnoid hematoma

Question 8

What is an epidural hematoma?

Answer 8

• bleeding in the space below the skull bone and above the dura mater
• onset rapid, bleeding from arteries
• minimal brain injury

Question 9

What injury is typically associated with epidural haematomas?

Answer 9

skull fracture

Question 10

What is a subdural hematoma?

Answer 10

• bleeding in the space below the dura mater and above the arachnoid mater
• onet slow = a week or more due to no visible head injury and veins bleed slower
• seriousness depends on amount of bleeding

Question 11

What injury is associated with a subdural hematoma?

Answer 11

violent movements to the head resulting in torn veins

Question 12

What is a subarachnoid hematoma?

Answer 12

bleeding in the space below the arachnoid mater and above the pia mater
- approx half will suffer some degree of life long impairment or chronic headache

Question 13

What injury is associated with a subarachnoid hematoma?

Answer 13

• cerebral aneurysm (stroke)

- skull fracture can also cause this

Question 14

How are head injuries categorised?

Answer 14

classified according to:

• mechanism
• clinically
• site of injury

Question 15

What are the anatomical classifications of head injury?

Answer 15

• focal

- diffuse

Question 16

Describe a focal head injury

Answer 16

scalp, skull, intracranial haemorrhage (laceration/contusion)

can be widespread trauma
ranges from a simple laceration to a penetrating injury

Question 17

Describe a diffuse head injury

Answer 17

widespread throughout the brain, e.g. diffuse axonal injury (DAI), ischaemia, swelling

Question 18

Describe scalp injuries

Answer 18

laceration - a tear of the dermis or underlying tissues and galea aponeurotica (aponeurosis) of the scalp

normally cause by contact injury
can rach subcutaneous fat or bone

Question 19

Describe skull injuries

Answer 19

fractures
The more severe the head injury, the higher the underlying suspicion of skull fracture should be
however, there is no direct correlation between damage to underlying brain parenchyma and skull fractures

Question 20

What is a depressed skull fracture?

Answer 20

the inner/outer tables of the skull are no longer in continuity and the inner table points down into the brain parenchyma

• cause injury to underlying brain parenchyma
• associated with a large force over a small area
• more common in children (nmostly not associated with brain injury)

Question 21

Describe an intracranial bleed

Answer 21

defined according to where the bleed is relation to the brain and meninges

• any ic bleed becomes a space occupying lesion and is associated with raised ICP
• can manifest with brain herniation at the severe end of the scale

Question 22

What is a extradural hematoma?

Answer 22

epidural accumulation of blood (dura separates from the skull)

Question 23

What is an ovoid clot?

Answer 23

egg-shaped clot formed by an epidural hematoma