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Neuro and Stroke > Head Injury > Flashcards

Head Injury Flashcards

1
Q

What is a head injury?

A

Any trauma to the skull or brain

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2
Q

How can head injuries be broadly classified?

A
  • Primary

- Secondary

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3
Q

What is a primary head injury?

A

Damage that occurs at time of impact

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4
Q

What are the types of primary head injuries?

A
  • Focal

- Diffuse

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5
Q

What are the type of focal head injuries?

A
  • Haematoma

- Contusion

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6
Q

What is a haematoma head injury?

A

Collection of blood within skull

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7
Q

What are the types of haematoma head injuries?

A
  • Extradural
  • Subdural
  • Intracerebral
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8
Q

What is a contusion?

A

Bruising of the brain, whereby blood mixes with cortical tissue due to micro haemorrhages and small vessel leaks

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9
Q

What is a coup contusion?

A

A contusion at the site of impact

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10
Q

What is a contra-coup contusion?

A

Contusion at a site opposite point of impact

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11
Q

What are the types of diffuse head injury?

A
  • Concussion

- Diffuse axonal injury

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12
Q

What is a concussion?

A

A head injury with temporary loss of brain function

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13
Q

What happens in a concussion?

A

Trauma leads to stretching of the axons

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14
Q

What does stretching of the axons in concussion lead to?

A
  • Impaired neurotransmission
  • Loss of ion regulation
  • Reduction in cerebral blood flow
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15
Q

What is a diffuse axonal injury?

A

Shearing of the interface between the grey and white matter following traumatic acceleration/deceleration or rotational brain injuries, damaging the intra-cerebral axons and dendritic connections

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16
Q

What can axonal death in diffuse axonal injury lead to?

A
  • Cerebral oedema
  • Raised ICP
  • Coma
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17
Q

What is a secondary brain injury?

A

Secondary brain injury occurs from insults to the brain after the initial injury (usually due to complications from the initial injury)

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18
Q

What can cause secondary brain injury?

A
  • Cerebral oedema
  • Haematoma
  • Increased ICP
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19
Q

What is a skull fracture?

A

A fracture of one or more of the bones of the cranial vault or skull base

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20
Q

How are skull fractures classified?

A
  • Appearance (linear or comminuted)
  • Location
  • Degree of depression
  • Open or closed
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21
Q

What are open fractures of the skull?

A

Fractures that communicate with the skin through a wound, sinus, the ear, or the oropharynx

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22
Q

What are the non-traumatic causes of (often secondary) head injuries?

A
  • Anoxia
  • Infection
  • CVA/TIA
  • Tumour
  • Metabolic disorder
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23
Q

What are the traumatic causes of open head injury?

A
  • Assault
  • Fall
  • Surgery
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24
Q

What are the causes of closed traumatic head injury?

A
  • Assault
  • Fall
  • Accident
  • Abuse
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25
Q

What is the main risk factor for head injury?

A

Male

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26
Q

How do mild head injuries present?

A
  • Headache
  • Confusion
  • Ringing ears
  • Fatigue
  • Changes in sleep pattern, mood or behaviour
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27
Q

How do moderate/severe head injuries present?

A
  • Confusion or aggression
  • Slurred speech
  • Coma or impaired consciousness
  • Persistent headache
  • Nausea or vomiting
  • Convulsions or seizures
  • Abnormal dilation of eyes
28
Q

What are some characteristic signs of basal skull fractures?

A
  • CSF otorrhoea or rhinorrhoea
  • Periorbital ecchymosis (raccoon eyes)
  • Battle’s sign (bruising over mastoid)
  • Haemotympanum
29
Q

What is the mainstay investigation of suspected brain injuries?

A

CT head

30
Q

When should adults receive a CT head within 1 hour of head injury?

A
  • Have GCS <13 when first assessed or <15 2 hours after injury
  • Suspected open or depressed skull fracture
  • Signs of basal skull fracture
  • Post-traumatic seizure
  • Focal neurological defecit
  • > 1 episode of vomiting
31
Q

When should children receive a CT head within 1 hour of head injury?

A
  • Clinical suspicion of NAI
  • Post-traumatic seizure
  • GCS <14 on initial assessment
  • GCS <15 on initial assessment if <1 year old OR 2 hours after injury
  • Suspected open or depressed skull fracture or tense fontanelle
  • Signs of basal skull fracture
  • Focal neurological deficit
  • Aged <1 with head bruise, swelling or >5cm laceration
  • More than one additional features
32
Q

What additional features should be looked at in children with suspected brain injury when considering CT head

A
  • Witnessed LoC >5 mins
  • Amnesia > 5 mins
  • Abnormal drowsiness
  • 3 or more discrete episodes of vomiting
  • Dangerous mechanism of injury
33
Q

What patients should receive CT head within 8 hours of head injury, regardless of other features?

A
  • Those with coagulopathy

- On oral anticoagulants

34
Q

What are the differentials for traumatic brain injury?

A
  • Intracranial haemorrhage (SAH)
  • Suture lines in children
  • Cephalohaematoma
35
Q

Where should patients with a head injury be taken?

A

Centre which can provide resuscitation and manage head injuries

36
Q

What initial treatment should patients with normal or near-normal GCS receive for head injury?

A
  • Check of haemodynamic status
  • Neurological assessment
  • Look for other possible injuries
37
Q

How should haemodynamic status be checked in patients with head injury and near normal GCS?

A
  • Pulse rate
  • Blood pressure
  • Fluid status
38
Q

What should a neurological assessment of a patient with a head injury and near-normal GCS include?

A
  • Full history and examination

- Pupil size and reaction to light

39
Q

What initial treatment should patients with a reduced GCS receive for head injury?

A
  • Resucitation

- Further assessment of GCS and pupils

40
Q

What are the indications for cervical spine immobilisation following head injury?

A
  • GCS <15 at any time
  • Neck pain or tenderness
  • Focal neurological deficit
  • Paraesthesia in extremities
  • Any other clinical suspicion of cervical spine injury
41
Q

Give some examples of criteria for admission to A&E with head injury?

A
  • High energy injury e.g. RTA
  • GCS <15 at any time
  • Any LoC
  • Any focal neurological deficit, vomiting, seizure, irritability or altered behaviour
  • Any suspicion of skull fracture or penetrating head injury
  • Any 65 or over
  • History of bleeding or clotting disorder or current anti-coagulant therapy
  • Suspicion of non-accidental injury
42
Q

Give some examples of criteria for longer admission to hospital in adults with head injury?

A
  • Abnormalities on imaging
  • GCS still below 15 after imaging
  • Continuing signs e.g. vomiting or headaches
  • Other injuries
  • Shock
  • Suspected non-accidental injury (NAI)
43
Q

Give some examples of criteria for longer admission to hospital in children with head injury?

A
  • History of LoC
  • Neurological abnormality
  • Persistent headache or vomiting
  • Evidence of skull fracture or penetrating injury
  • Suspicion of NAI
  • Difficulty in making full assessment
  • Other significant medical problems
44
Q

How can management of traumatic brain injury be divided?

A
  • Acute phase

- Chronic phase

45
Q

What is the aim of the acute phase management of traumatic brain injury?

A
  • Stabilise patient

- Focus on preventing further injury

46
Q

Why is the focus of acute phase management of traumatic brain injury not to reverse initial damage?

A

Not usually possible

47
Q

What can be involved in the acute management of a traumatic brain injury?

A
  • Ensure proper oxygen supply
  • Maintain adequate blood flow to the brain
  • Control raised ICP
  • Prevent and treat any seizures
  • Manage pain
48
Q

What may be required in serious head injury to ensure proper oxygen supply?

A

Endotracheal intubation and mechanical ventilaiton

49
Q

How can hypotension be managed in traumatic head injury?

A
  • Fluids

- Adrenaline/similar drugs

50
Q

How can raised ICP be managed following traumatic head injury?

A
  • Tilt bed and straighten neck to promote venous return
  • Sedate the patient
  • Analgesia
  • Mannitol can be used
51
Q

How should seizures following traumatic head injury be managed?

A

Benzodiazepines

52
Q

Why is important to manage pain following an acute head injury?

A

Pain can raise ICP

53
Q

What are the indications for neurosurgical opinion following traumatic head injury?

A
  • Surgically significant abnormalities on imaging
  • Persisting GCS <8 (coma)
  • Unexplained confusion beyond 4 hours
  • Deterioration of GCS after admission
  • Progressive focal neurological symptoms
  • Seizure without skull fracture
  • Definite or suspected penetrating injury
  • CSF leak
54
Q

What can neurosurgical intervention help to manage?

A
  • Mass lesions e.g. haematomas
  • Contusions
  • Penetrating objects
55
Q

What surgical intervention can help to manage raised ICP?

A

Decompressive craniectomy

56
Q

What should patients be referred for following acute management of traumatic head injury?

A

Rehabilitation

57
Q

What is the aim of rehabilitation following a traumatic head injury?

A

To improve independent functioning at home or in society and help adapt to disabilities

58
Q

Which professionals are often involved in rehab post-traumatic brain injury?

A
  • Neurologists
  • Physios
  • SALT
  • OT
  • Mental health professionals
59
Q

How can rehabilitative care be delivered post-traumatic brain injury?

A
  • Inpatient treatment unit
  • Outpatient
  • Community based
60
Q

What further care may patients who cannot live alone or with family require post-traumatic brain injury?

A

Care in living facilities

61
Q

What are the potential complications of traumatic head injury?

A
  • Amnesia
  • Raised ICP and cerebral oedema
  • CSF leak
  • Cerebral herniation
  • Intracranial or extracranial haemorrhage
  • Meningitis
  • Seizures
  • Permanent disability
62
Q

Where can CSF leak following a traumatic head injury?

A
  • Nose

- Ear

63
Q

How can CSF leak from the nose following a traumatic head injury?

A

Fracture of cribriform plate

64
Q

What should patients with CSF rhinorrhoea not do?

A

Blow their nose

65
Q

How can CSF leak from the ear following a traumatic head injury?

A

Fracture of temporal bone

66
Q

What may be involved if there is CSF otorrhoea?

A
  • Facial nerve

- Vestibulocochlear nerve

67
Q

What permanent disabilities may occur after a traumatic head injury?

A
  • Neurodegenerative deficits
  • Delusions
  • Speech or movement problems
  • Intellectual disability
  • Coma or persistent vegetative state

Neuro and Stroke (33 decks)

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