Head Injury

Question 1

Causes/ Risk factors

Answer 1

If the pupils are unequal, diagnose rising ICP and summon urgent neurosurgical help. Retinal vein pulsation at fundoscopy helps exclude ICP

Potential complications

Early

• Extradural/subdural haemorrhage
• Seizures

Late

• Subdural haemorrhage
• Seizures
• Diabetes insipidus
• Parkinsonism
• Dementia

Question 2

Symptoms/ Signs

Answer 2

Skull fracture signs:

• Panda eyes (2 huge bruises around each of the eyes)
• Bruise behind ears
• Blood in ear canal: hemotympanum
• CSF rhinorrhea and otorrhea
• Rashes to check for meningitis
• Papilledema
• Bleeding from wound/ bruise @ wound site

Unconscious

Headache

Dizziness

Blurred vision

Confusion and disorientation

Nausea and vomiting

Varies depending on severity

Low GCS - Hypotension and bradycardia

Question 3

Investigations

Answer 3

1. ABC - c spine control, incubated and ventilated then expose for other injuries
2. Oxygen saturation
3. Pulse, BP, temperature, RR, pupil:watch ICP as this can say a lot about the blood flow
4. Assess anterograde amnesia
5. U&E
6. Glucose
7. FBC
8. Blood alcohol
9. Toxicology screen
10. CT head

• Loss of ventricles -raised ICP
• Small extradural haematoma on LHS
• Blood inside frontal lobe - contusions. - will get better over time but will have some long lasting cognition effects
• Raised ICP - agitation, headaches, V and dizziness
• • Subdural haematoma causing midline shift - important to take care of
• Subcutaneous haematoma (outside skull)
• Young pt - defo straight to surgery - if big then craniotomy (with elderly with multiple morbidities then they would not tolerate it)