Head Injury Flashcards
what is the difference between - primary brain injury - secondary brain injury
primary – occurs at the time of the incident secondary – occurs as a consequence
how does secondary brain injury occur
loss of blood brain barrier – leucocyte infiltration – inflammation loss of cerebral auto regulation of BP – ishaemia
how is cerebral perfusion pressure (CCP) calculated
CPP = MAP - ICP MAP - mean arterial pressure ICP - intracranial pressure
what is the normal range for ICP
9-11mmHg
what is the ideal CCP post head injury
>60mmHg
what has a major influence on CCP
hypotension
racoon/panda eyes is a sign of what injury
anterior cranial fossa fractures
what is a ‘battle sign’ over the mastoid area a sign of
posterior cranial fossa/ basilar skull fracture
what are the 3 parts to the Glasgow coma scale
- eye opening 2. verbal response 3. best motor response
what is the GCS scored between?
3-15
what GCS indicates a coma
sum of 8 or less
GCS scoring for eye opening
spontaneously = 4 to command = 3 to pain = 2 none = 1
GCS scoring for verbal response
orientated = 5 confused = 4 inappropriate words = 3 sounds = 2 none = 1
GCS scoring for best motor response
obeys command = 6 localises to pain = 5 flexes to pain = 4 abnormal flexion = 3 extension = 2 none = 1
when should a patient receive a CT scan with a head injury
skull fracture focal neurological signs e.g. 3rd never palsy, focal weakness GCS <15 if on anti-coagulants
what type of head injruy is this
extra-dural haematoma
what kind of brain injury is this
subdural haematoma
who gets subdural haematomas
elderly
alcoholics
treatment of subdrual haematoma
surgical evacuation of haematoma
how does an extradural head injury affect ICP
causes raised intracranial pressure
- decreases GCS
management of an extradural haematoma
urgent surgical decompression
what is a decompressive craniectomy
surgical removal of part of the skull to allow the brain to swell without being squeezed
what are the late effects of a head injury
epilepsy – seen within first 2 weeks
CSF leak – into nose/ear
Cognitive problems – post concussion syndrome
signs of post concussion syndrome
poor concentration
headache
poor memory
lethargy
what is a brain contusion
bruising of the brain due to head injury
what is concussion
sudden, short lived loss of mental function that occurs after a head injury
symptoms of concussion
headahce
nausea
dizziness
balance problems / lack of motor co-ordination
what drug can be given to protect the cerebrum after injury
mannitol
- reduces swelling + pressure
hypodense (dark) cresenteric collection around convexity of brain on CT indicates what head injury?
chronic subdural haematoma
