Head injury

Question 1

Primary insult to the head

Answer 1

-Focal/diffuse brain trauma

Question 2

Secondary insult

Answer 2

• Hypotension
• Hypoxia
• Infection
• Haematoma

Question 3

Initial assessment of a head injury is via?

Answer 3

Glasgow coma scale

Question 4

How does the GCS rate head injury

Answer 4

1-15
15-13: Mild injury
12-9: moderate injury
3-8: severe injury

Question 5

Eye opening in GCS

Answer 5

Spontaneous: 4
To loud voice: 3
To pain:2
Not at all: 1

Question 6

Verbal response in GCS

Answer 6

orientated: 5
confused: 4
Inappropriate:3
Incomprehensible: 2
None: 1

Question 7

Motor response in GCS

Answer 7

Obeys:6
Localises :5
Flexion:4
Abnormal flexion (twisted arm) :3
Extension posturing :2
None :1

Question 8

Consequences of head injury

Answer 8

• Physical disability
• Post-traumatic epilepsy
• Intracranial infection
• Psychiatric illness
• Chronic subdural haematoma
• Punch-drunk dementia- dementia associated with head injury
• Fatal outcome

Question 9

How do head injuries occur?

Answer 9

• Debilitating disease
• Accidental
• Homicidal

Question 10

Different types of head injuries

Answer 10

• Scalp
• Skull fractures
• Haemmorage
• Diffuse traumatic axonal injury
• Intrinsic brain injury

Question 11

Scalp injuries

Answer 11

Abrasions/ lacerations
Often associated with damage to the skull
Blunt laceration can lead to damage which might not be superficial on the scalp
Hair might cover size of tear
Bleeding and bruising may be present in the deeper layers of the scalp closer to the skull

Question 12

Different types of skull fracture

Answer 12

Linear
Depressed
Comminuted 
Ring fracture
Coutre-coup

Question 13

What is a linear fracture

Answer 13

• Usually at parieto-temporal suture
• Due to fall onto top or side of head
• Continues into skull base

Question 14

What is a depressed fracture

Answer 14

Fracture which leads to sections of the brain being pushed in against blood vessels

Question 15

what is a comminuted fracture

Answer 15

Fragmented skull

Question 16

What is a ring fracture

Answer 16

Damage to foramen magnum

Related to brainstem and spinal cord being pushed together- usually a result of a fall from a height landing on feet

Question 17

What is a contre-coup

Answer 17

Fracture from hitting the head on the back

Leads to damage in the anterior cranial fossa

Question 18

which are the parts of the skull which can be affected by a fracture?

Answer 18

• Skull base: anterior/middle and posterior cranial fossa

- Skull vault: skull and sutures

Question 19

Intracranial hemmorage types

Answer 19

• Extradural
• Subdural
• Subarachnoid

Question 20

What is an intracranial hemmorage

Answer 20

A build up of blood in the brain which leads to an increase in intracranial pressure.
The increase in pressure can ultimately lead to compression of the Braim.
If the compression leads to the cerebral tonsils being pushed against the spinal cord this will lead to death.

Question 21

Characteristics of a extradural hemmorage

Answer 21

Blood between the dura and the skull
Build up of blood here will eventually lead to the dura being pulled off the skull
Usually associated with large pressure arteries rather than veins in reaction to a skull fracture
Commonly associated with a Middle meningeal artery rupture of the pterion

Build up of intracranial pressure- can take hours for symptoms to present:

• Patient may have a lucid period where they appear to be completely fine
• This can have catastrophic consequences

Question 22

Characteristics of a subdural hemmorage

Answer 22

Usually related to the fracture of veins which drain the venous sinuses underneath the dura.
It is usually caused by a rotational sheer force which causes the vessels to rupture.

Question 23

Who is likely to suffer from a subdural hemmorage?

Answer 23

• People with atrophic brains: more room between the brain and the skull
• In the elderly: can present as chronic. Often mistaken with dementia as it causes loss of lucidity

Question 24

Characteristics of a subarachnoid hemorrage

Answer 24

Most commonly associated with disease: e.g. rupturing of cerebral arteries.
Usually sudden death due to the irritant effects of blood

Question 25

Traumatic basal SAH

Answer 25

Associated with a severe blunt to the neck which cause rotational movement of head- this causes the circle of willis to become ruptured and SAH on the base of the brain.

Question 26

Examples of intrinsic brain injury

Answer 26

• Cerebral oedema

- Cerebral contusion: mechanical damage to the brain

Question 27

Different types of cerebral contusion?

Answer 27

Coup contusion:

• when head stuck with blunt force
• Contusion is found directly under the strut area

Contre-coup:

• when moving head strikes against object
• Contusions are found diametrically opposite the site of head impact

Question 28

How is diffuse axonal injury diagnosed?

Answer 28

• Diagnosis can only be made based on microscopy of the brain
• Small vessels involved/damaged may increase suspicions
• Usually associated with vehicle incident/ falls from a height
• Rotational forces to the head lead to shearing of axons

Question 29

which areas are most prone to diffuse traumatic axonal injury?

Answer 29

• corpus callosum
• Cereberllar peduncles
• Posterior internal capsule
• para-sagittal white matter