Head Injury ****

Question 1

Different type of skull fractures?

What is a contusion?

Answer 1

Linear
Depressed
Open
Basal

Areas of focal brain injury either by direct damage by impacted skull or brain is squashed remotely from area of impact.

Question 2

Traumatic brain injury - what is it?

What is used to classify it?

Answer 2

Any head or neck injury which results in disruption of brain function

GCS

Question 3

GCS:

What is classed as mild, moderate and severe?

Answer 3

13-15

9-12

<8

Question 4

Pathological consequences of head injury?

What is secondary brain injury?

Answer 4

Raised ICP
Focal neurological deficits
Secondary brain injury - reduced perfusion from raised ICP, vascular damage or hypovolaemia

Question 5

Define concussion using GCS

Symptoms:

• behaviour
• amnesia - 2 types and define?
• how long could you lose consciousness for before it becomes more than a concussion?

-What other symptoms may last for hours to days?

Answer 5

Mild TBI - GCS 13-15 at 30 mins post injury

Mild behavioural or cognitive changes - e.g. confusion

Retrograde - can’t remember the event
Anterograde - can’t create new memories after event

30 minutes - I THINK THIS SHOULD BE SECONDS

Headache 
N&V
Dizziness 
Imbalance 
Fatigue 
Irritability

Question 6

Subdural Haematoma - the commonest type

S+S:

Acute/chronic

3 A’s mneumonic for risk factors

Answer 6

Drowsy 
Physical and cognitive slowing, personality changes 
N&V
Signs of raised ICP 
Urine incontinence 

Can be acute or chronic

Age
Anticoagulation
Alcohol

Question 7

Epidural haematoma and herniation - what it also known as?

Where does the blood come from?

What type of fracture is this associated with?

Why is this one bad?

Answer 7

extradural haematoma/haemorrhage

Vessels supplying skull or dura
MIDDLE meningeal artery beneath temple the main one

Temporal fracture

High mortality

Question 8

Epidural haematoma and herniation:

What would you get from the initial impact?

What happens during the lucid period (a temporary improvement in a patient’s condition after a traumatic brain injury)?

What happens after the lucid period?

Answer 8

Loss of consciousness/concussion

Haematoma expands and initially accommoadated

No longer accommodated and raised ICP leads to further loss of consciousness and uncalled herniation through the tentorium (LOOK AT PICS)

Question 9

Epidural haematoma and herniation:

What happens from the compression of CN3?

What happens later on which leads to death?

Answer 9

Dilated pupils on affected side with contralateral hemiparesis

Other pupil affected eventually
Coning of brainstem through foramen magnum

Question 10

Investigations:

Initial assessment?

What indicates how severe this is?

Criteria for scanning - CSF NOT BAD - mneumonic

Answer 10

ABCDE (include GCS)

Extent of amnesia

Comatose - GCS<13
Seizure
Suspected skull (f)racture

Focal (n)neurological deficit
Old
Two or more vomiting episodes

Blood thinners or bleeding disorders
Amnesia
Dangerous

Question 11

Suspected base of skull fracture:

5 signs - name them!

Answer 11

Panda eyes - periorbital ecchymoses

Battle signs - mastoid ecchymoses

Haemotympanum

CSF rhinorrhea

CSF otorrhea

Question 12

CT head findings:

Extra-dural haemorrhage - 2

Subdural haemorrhage - 3

Answer 12

Lentiform shape - GOOGLE - looks like a lemon
Skull fracture

Banana shape all along one side
Midline shift
Shrunken ventricles

Question 13

CT head findings:

SAH - 1

Ischaemic stroke - 1

Ring-enhancing lesions - what is it? in what is it seen?

Answer 13

Hyperdense (white) areas 
In basal (ganglia) cisterns and sulci highlighting their shape

GOOGLE

Hypoattenuation in a vascular distribution

Walls are vascularised but the core isn’t

Abscess or brain tumour

Question 14

Management:

Initial

When is a neurological referral needed?

When is urgent referral? - 2

Answer 14

Analgesia as pain can raise ICP

Persistent symptoms after initial Rx
Focal neurological deficits
Significant findings on CT

GCS<8
Open fracture