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Y3 NEUROLOGY > Head Injury > Flashcards

Head Injury Flashcards

1
Q

What is the difference between primary + secondary brain injury due to head injury?

A

Primary: neuronal damage occuring at time of injury (unpreventable)
Secondary: occurs due to consequence of injury (partly preventable) e.g. oedema, haemorrhage

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2
Q

What is the normal range for adult intracranial pressure?

A

9-11 mm Hg

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3
Q

What does a patient with an anterior cranial fossa fracture look like? (buzzword)

A

Racoon/panda eyes

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4
Q

What does a patient with a middle cranial fossa fracture look like? (buzzword)

A

Battle sign bruising over mastoid area

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5
Q

A coma equates to what score on the Glasgow Coma Score? What are the other features that must be present in coma?

A

8 or less

No eye opening, no obeying commands, no speech

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6
Q

When should a CT scan be requested in head trauma?

A 
Any one of the following:
Suspected skull fracture
GCS less than 15 (not orientated)
Focal neurological signs
Taking anticoagulants
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7
Q

List intensive care management of head injury

A 
Sedation
Ventilation
BP management
Glucose maintenance
Temperature maintenance
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8
Q

How does sedation help in management of head injury?

A

Reduces cerebral metabolic rate, blood flow and ICP

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9
Q

What are the two types of head injury?

A

Open (penetrating, missile)

Closed (non-missile)

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10
Q

Closed head injury can be split into three types depending on direction of force. What are they?

A

Acceleration
Deacceleration
Rotation

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11
Q

Define Monro Kielle Hypothesis

A

Skull is a closed box structure with limited expansion in response to pressure

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12
Q

How is cerebral perfusion pressure calculated?

A

MAP - ICP

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13
Q

What CPP is aimed for after a head injury?

A

> 60 mmHg

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14
Q

What type of cerebral autoregulation is damaged in trauma?

A

Focal cerebral autoregulation

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15
Q

Describe what is meant by ‘ischaemic penumbra’

A

Ischaemic but still viable cerebral tissue (typically surrounds dense ischaemic core)

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16
Q

What physical findings might you expect after head injury?

A

Scalp swelling/ laceration
Skull vault fracture
Skull base fracture

17
Q

What are the three main areas tested in the Glasgow Coma Scale?

A

Eye opening
Verbal response
Best motor response

18
Q

What is the function of the GCS?

A

To assess consciousness

19
Q

What is the range of scores you can achieve in the GCS?

A

3 - 15

20
Q

What score on the GCS is typically achieved in mild head injury?

A

13 - 15

21
Q

What are the main 3 causes of mortality in coma as a result of head injury?

A

Hypoxia
Hypotension
Raised ICP

22
Q

List the main pathology associated with traumatic intracranial bleeding

A

Extradural haematoma
Subdural haematoma
Intracerebral haematoma
Traumatic SAH

23
Q

List management options to treat raised ICP

A 
CSF drain
Mannitol
Hyperventilation
Hypothermia
Decompressive craniectomy
24
Q

What is the mechanism of action of mannitol in treating raised ICP?

A 
Increases microperfusion
Reduce oedema (acts as a diuretic)
25
Q

List the potential late effects of head injury

A 
Post-traumatic epilepsy
CSF leakage (into nose or middle ear)
Cognitive problems ('post-concussive syndrome')
26
Q

List the 5 levels of the Glasgow outcome scale

A
  1. Dead
  2. Persistent vegetative state
  3. Severely disabled
  4. Moderately disabled
  5. Good recovery
27
Q

Define ‘vegetative state’

A

Sleep wake cycles are preserved but no other interaction - e.g. eye tracking, response to stimulation

28
Q

List the characteristic clinical finding on CT scan found in extradural haematoma?

A

Hyperdense lens-shaped lesion

29
Q

List the characteristic clinical finding on CT scan found in subdural haematoma?

A

Crescent-shaped ‘banana’ lesion (acute: hyperdense, chronic: hypodense)

30
Q

What are the clinical symptoms of extradural haematoma?

A

Typically young person whol falls and hits head
Brief loss of consciousness followed by an interval and then symptoms - headache, V, CL hemiparesis, IP pupillary dilatation

31
Q

What are the clinical symptoms of subdural haematoma?

A

Typically, elderly person who falls or NAI
Acute - reduced consciousness
Chronic - increasing loss of consciousness, headaches, confusion, weak, seizure, gait abnormality, cognitive impairment

32
Q

What is the classical origin of extradural haematoma?

A

Middle meningeal artery

33
Q

What is the classical origin of subdural haematoma?

A

Cerebral bridging veins

Y3 NEUROLOGY (22 decks)

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