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Nervous System > Head Injury > Flashcards

Head Injury Flashcards

1
Q

What are the two stages of insult?

A

Primary and secondary

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2
Q

Describe the primary insult

A

Focal and/or diffuse brain trauma

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3
Q

Describe the secondary insult

A
  • Hypotension
  • Hypoxia
  • Infection
  • Haematoma
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4
Q

What is used to assess conscious level?

A

Glasgow Coma Scale

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5
Q

Describe the outcome of Glasgow coma scale

A

Correlates with severity of head injury:
• 13-15 - mild injury
• 9-12 - moderate injury
• 3-8 - severe injury

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6
Q

Name seven complications of head injury?

A
  1. Permanent physical disability – paralysis, loss of motor function or speech
  2. Post traumatic epilepsy
  3. Intracranial infection
  4. Psychiatric illness – depression, PTSD
  5. Chronic subdural haemorrhage
  6. ‘Punch-drunk’ dementia
  7. Fatal outcome (uncommon)
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7
Q

What are some reasons a person might fall?

A
  • Accidental (falls, RTAs)
  • Homicide - consequence of being struck by a weapon
  • Natural disease can cause collapse with resulting head injury which can prove misleading on initial investigation
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8
Q

What are the five layers of the scalp

A

Skin, Connective tissue, Aponeurotic fascia, Loose connective tissue, Pericranium

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9
Q

What does the skull consist of?

A

Compact bone separated by spongy bone

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10
Q

Describe the meninges

A
  • Dura mater (dense, tough, fibrous, adherent to inner surface of the skull)
  • Arachnoid mater (delicate, transparent, envelopes the brain)
  • Pia mater (delicate, applied to the brain surface)
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11
Q

Describe scalp injuries

A
  • Laceration clean cut and bleed profusely
  • Blunt force trauma may no be visible on the scalp
  • Hair can obscure injuries
  • May only have bruising/bleeding in the deeper layers of the scalp or between the scalp and skull
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12
Q

What are the two element to the skull?

A
  • Skull vault (upper part) - frontal bone, squamous temporal bone and occipital, separated by sutures
  • Skull base which can be divided into the anterior, middle and posterior cranial fossa
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13
Q

What are five different types of skull fractures?

A
  • Linear
  • Depressed
  • Comminuted (mosaic
  • Ring fracture
  • Contre-coup
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14
Q

Describe linear skull fractures

A

Commonly temporo-parietal from blow or fall onto side or top of the head and may continue onto the skull base; “hinge” fracture as it will split along a suture i.e. sagittal and then the two sutures coming off of it

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15
Q

Describe focal skull fractures

A

Focal impact which may push fragments inwards to damage the meninges, blood vessels and the brain; risk of meningitis and post-traumatic epilepsy. Not typical of a fall from standing onto a flat surface

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16
Q

Describe committed (mosaic) fractures

A

Fragmented skull

17
Q

Describe ring fractures

A

Fracture line encircling the foramen magnum caused by a fall from height, usually landing on the feet, but sometimes the head, leading to the skull base and cervical spine being forced together

18
Q

Describe contre-coup fractures

A

Fracturing of the orbital plates (anterior fossa) caused by a fall onto the back of the head

19
Q

How are intracranial haemorrhages named?

A

By their position in the skull i.e extradural, subdural and subarachnoid haemorrhage

20
Q

What is an intracranial haemorrhage?

A

Accumulation of blood within the rigid skull which causes an increase in intracranial pressure (ICP) and results in compression of the brain –> this compression causes symptoms, including reduction in conscious level

As ICP increases, without intervention, death will occur by compression of the brainstem due to herniation of the cerebellar tonsils into the foramen magnum

21
Q

What is an extra dural haemorrhage?

A

Bleeding occurring between the dura and the skull; accumulating blood strips the dura from the inner surface of the skull

Most due to damage to an artery is association with skull fracture

22
Q

What artery classically causes an extra dural haemorrhage?

A

Middle meningeal artery where is crosses the inner aspect of the squamous temporal bone due to fracture of that bone with secondary damage to the artery in the vicinity of the fracture

23
Q

Describe the outcomes of an extradural haemorrhage

A

Causes raised intracranial pressure with developing neurological symptoms; the time period for the development of symptoms is variable

“Lucid interval” can occur - victim of injury initially seems to be okay, without neurological symptoms, but can deteriorate catastrophically later

24
Q

What is a subdural haemorrhage?

A

Bleeding occurring beneath the dura (and above the arachnoid)

Usually caused by bleeding from bridging veins which pass from the surface of the brain to drain into the large venous channels within the dura

25
Q

What is the pathway behind formation of a subdural haematoma?

A

Any motion which causes rotational or “shearing” forces can cause the veins to be stretch and torn due to the relative movement between the brain and the dura - frequently occurs with skull fracture.

Chronic subdural haemorrhage can occur, usually in elderly, and may be a cause of chronic confusion (may be mistaken with dementia)

26
Q

Why are individual with atrophic (small) brains at an increased risk of a subdural haematoma?

A

The smaller brain has greater capacity for movement and the veins may be already stretched to some degree

27
Q

What is a subarachnoid haemorrhage?

A

Bleeding beneath the arachnoid membrane

28
Q

What is the most common cause of a subarachnoid haemorrhage?

A

Natural disease; rupture of a cerebral artery (‘berry’) aneurysm - main risk factor is hypertension

29
Q

Name a specific type of subarachnoid haemorrhage

A

Traumatic basal SAH

30
Q

What is traumatic basal SAH?

A

Result of a forceful impact to the upper part of the side of the neck causing abrupt rotational movement of the head leading to rupture of the vertebra-basilar circulation and SAH on the base of the brain

Collapse is usually rapid and death can occur very quickly due to the irritant effects of blood in the subarachnoid space.

31
Q

What are two potential consequences of intrinsic brain injury?

A
  • Cerebral oedema

* Cerebral contusion and laceration

32
Q

Describe cerebral oedema

A

Can develop in minutes and lead to massive brain swelling with raised intracranial pressure and “coning” (herniation)

33
Q

Describe cerebral contusion and laceration

A

Direct mechanical damage to the brain substance which can occur anywhere on the brain

Two types: coup and contre-coup

34
Q

Describe the two types of cerebral contusion and laceration injuries

A
  • Coup - occurs directly under site of impact
  • Contrecoup - caused by a moving head striking a fixed object or unyielding surface - contusions are found diametrically opposite the site of head impact
35
Q

What is an axon?

A

Elongated processes of nerve cells which permit transmission of signals between different parts of the brain and between the brain and body

Nervous System (47 decks)

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