Head injury

Question 1

Name 2 types of skull fracture

Answer 1

Anterior Basilar Skull fracture

Posterior Basilar Skull fracture

Question 2

List 5 general symptoms of head injury

Answer 2

Headache 
Dizziness 
Blurred vision 
Confusion + disorientation 
N+V

Question 3

What is a head injury?

Answer 3

Trauma to the head +/- soft tissue injury, skull fractures + traumatic brain injury

Question 4

What are the 2 types of head injury?

Answer 4

Closed head injury (most common): head injury with intact dura mater
Open head injury: head injury with a breach in dura mater exposing cranial contents to the environment

Question 5

What is a traumatic brain injury?

Answer 5

structural or physiological disruption of the brain resulting from a head injury

Question 6

Give 3 aetiologies of head injury

Answer 6

Blunt head injury (common)
Penetrating head injury (less common)
Blast injuries

Question 7

What is a blunt head injury?

Answer 7

injury caused by blunt force trauma to the head
Falls: leading cause of TBI; more common in children, YA’s + elderly
Motor vehicle accidents: 2nd most common cause of TBI
Contact sports (e.g., football)

Question 8

What is a penetrating head injury?

Answer 8

injury caused by penetrative trauma to the head
Gunshot wounds
Assault or accidental injury with a penetrating foreign body to the head or face (e.g. knife, screwdriver)

Question 9

What is a blast head injury?

Answer 9

injury caused by the high pressure wave (blast wave) generated from an explosion; common in active military or war zones

Question 10

What indicates rising ICP after a head injury? What should you do? What may help exclude rise in ICP?

Answer 10

Unequal pupils
Summon urgent neurosurgical help.
Retinal vein pulsation at fundoscopy helps exclude ICP

Question 11

Give 3 early complications of a head injury

Answer 11

Extradural haemorrhage
Subdural haemorrhage
Seizures

Question 12

List 5 late complications of a head injury

Answer 12

Subdural haemorrhage 
Seizures 
Diabetes insipidus 
Parkinsonism 
Dementia

Question 13

Describe immediate management of head injury

Answer 13

ABCDE 
A: C-Spine immobilisation, intubation
B: Oxygenation
C: Control BP
D: GCS
E: identify other injuries

Question 14

What basic investigations should be carried out for head injury?

Answer 14

Oxygen saturation 
Pulse
BP
Temperature
RR
Pupils: identify ICP
Assess anterograde amnesia

Question 15

What bloods should be taken post-head injury?

Answer 15

FBC 
U+E 
Glucose: identify cause
Blood alcohol: identify cause
Toxicology screen: identify cause

Question 16

What further investigations may be performed in head injury?

Answer 16

CT head

MRI head

Question 17

What scoring system can be used to assess traumatic brain injury?

Answer 17

Glasgow Coma Scale

Question 18

Give 3 features of a anterior Basilar Skull fracture

Answer 18

Blood pooling from these fractures can cause:
Periorbital bruising (raccoon eyes)
CN I, V, VI, VII + VIII palsies
CSF rhinorrhoea.

Question 19

Give 3 features of a posterior Basilar Skull fracture

Answer 19

Hearing impairment (conductive due to haemotympanum)
CSF otorrhoea
Brusing over the mastoid area (Battle’s sign)
CN VI, VII + VIII palsies.

Question 20

List 6 general signs of head injury

Answer 20

Haematoma + inflammation
LOC 
CSF rhinorrhea + otorrhea  
Papilledema  
Low GCS
Cushing Triad: HTN, bradycardia, irregular RR