Head Injury and Coma Flashcards
Presentation of extradural haematoma
Recent head injury
Headache, nausea, vomiting, altered mental state, and sometimes seizures
May regain normal level of consciousness (lucid interval) but gradually lose consciousness
Raised ICP
May also present with a 6th nerve palsy
Diagnosis of extradural haematoma
CT head
Bi-convex (lentiform) haematoma which is hyper-dense
Management of extradural haematoma
In patients with no neurological deficit, cautious clinical and radiological observation
Definitive treatment is craniotomy and evacuation (Burr holes)
Acute subdural haematoma causes
High impact trauma
Presentation of acute subdural haematoma
Spectrum of severity of symptoms and presentation depending on size of the compressive acute subdural haematoma and associated injuries
Ranges from incidental finding in trauma to severe coma and coning due to herniation
Investigations in acute subdural haematoma
CT head
Crescentic hyperdense collection, not limited by suture lines
Management of acute subdural haematoma
Small/incidental can be observed conservatively
Surgical options include monitoring of ICP and decompressive craniectomy
Define chronic subdural haematoma
Collection of blood within the subdural space that has been present for weeks to months
Risk factors for chronic subdural haematoma
Elderly
Alcoholic
Presentation of chronic subdural haematoma
Typically a several week to month progressive history of either confusion, reduced consciousness or neurological deficit
Investigations in chronic subdural haematoma
CT head
Cresenteric hypodense collection, limited by suture lines
Management of chronic subdural haematoma
If incidental/small with no associated neurological deficit then it can be managed conservatively
If symptoms burr holesis required
Common cause of subarachnoid haemorrhage
Usually occurs spontaneously in context of a ruptured cerebral aneurysm
Risk factors for intracerebral haematoma
Hypertension
Vascular lesion (e.g. aneurysm/arteriovenous malformation)
Cerebral amyloid angiopathy
Trauma
Brain tumour
Infarct
Investigations in intracerebral haematoma
CT head
Hyperdense lesion within substance of the brain
Criteria for 1 hour post-injury CT head
GCS <13 on initial assessment in ED
GCS <15 at 2 hours after the injury on assessment in ED
Suspected open or depressed skull fracture
Any sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
More than 1 episode of vomiting
Criteria for 8 hours post-injury CT head
Loss of consciousness/amnesia plus any of:
> 65
History of bleeding or clotting disorders
Dangerous mechanism of injury
More than 30 minutes’ retrograde amnesia of events immediately before the head injury
On warfarin with no other indications for a CT head
Signs of basal skull fracture
Haemotympanum
“Panda” eyes
CSF leakage from ear or nose
Battle’s sign
Management of GCS <8
ABCDE
Focussed neuro exam
