Head injury and concussion

Question 1

Symptoms of head injury

Answer 1

• history of head impact
• headache
• vomiting
• double or blurred vision

Question 2

Signs of head injury

Answer 2

• confusion
• drowsiness
• unconsciousness
• pupil abnormalities
• evidence of cutaneous injury
• Battle sign (bruising of mastoid) or Panada eyes (blood around soft tissue of eyes)

Question 3

What is the difference between primary and secondary brain injury?

Answer 3

primary - damaged caused at time of impact

secondary - inflammatory cascade that develops as a result of injury

Question 4

What is the pathophysiology of secondary brain injury?

Answer 4

• loss of cerebral auto regulation (get areas of ischaemia)
• breakdown of BBB
• neuronal swelling
• brain oedema
• cell death and release of excitatory neurotransmitter and positive feedback of more cell death
• calcium and inflammatory damage

Question 5

How is GCS used?

Answer 5

Eyes (open, open to voice, to pressure or no eye opening)
Verbal (orientated, confused, words, sounds or none)
Motor (Obey command, localises to pain, flexes to pain, abnormal flexion, extension to pain or none)
Best score would be 15 lowest possible is 3

Question 6

What is a extradural haematoma?

Answer 6

laceration of middle meningeal artery which bleeds into extradural space and forms a blood clot
(often secondary brain injury not primary)

Question 7

What is the classic presentation of extradural haematoma

Answer 7

lucid phase, injured fine for a few hours with headache then start getting rapid deterioration

Question 8

How is extradural haematoma treated?

Answer 8

surgical removal

Question 9

When should a scan be done for a head trauma?

Answer 9

if GCS is below 13 or if patients are on warfarin or other medication with increased bleeding risk

Question 10

What are the types of subdural haematoma?

Answer 10

Acute - very severe, high risk of death, often causes midline shift (blood clot pushes ventricles)
Chronic - more common in elderly, not likely to be fatal

Question 11

How can aneurysm SAH and traumatic be distinguished?

Answer 11

traumatic will have cutaneous injury and history of trauma

can do CT angiogram to check for aneurysm

Question 12

What are contusions?

Answer 12

bruising

Question 13

How are cerebral contusion treated?

Answer 13

most commonly left to get better on their own

Question 14

What occurs in diffuse axonal injury?

Answer 14

shearing of internal structures, get conduction block
can’t be seen on scan, only see slight bleeding but can diagnose with symptoms
No treatment

Question 15

What is the function of decompressive craniectomy?

Answer 15

• reduce pressure to stop ischameia

- bone can then be put back on when swelling has reduced

Question 16

What factors will influence outcome of brain injury?

Answer 16

• age (better if younger)
• post resuscitation GCS
• pupillary response
• hypotension
• Hypoxia
• CT findings
• other injuries

Question 17

What two factors are most important to fix to improve outcomes?

Answer 17

Hypotension

Hypoxia

Question 18

How are head injuries treated?

Answer 18

1) treat hypotension and hypoxia
2) intubate if GCS below 8
3) treat co-existant injuries
4) shave hair and suture lacerations to prevent bleeding and infection
5) removal intracranial haematomas
6) monitor intracranial pressure
7) maintain adequate fluid intake
8) monitor sodium levels

Question 19

How are epilepsy and traumatic brain injury related?

Answer 19

• severe brain injury increases risk of epilepsy, big increase immediately after trauma
• risk decreases over a few years but still greater risk

Question 20

What can be the longer term neurocogntive or behavioural impacts of TBI?

Answer 20

• short term memory dysfunction
• executive dysfunction
• language dysfunction
• numerical dysfunction
• personality changes
• psychiatric effects (anxiety, depression, psychosis)

Question 21

What is a concussion?

Answer 21

form of TBI where no abnormalities on scan (no pathological abnormality) or examination but symptomatic

Question 22

What are the symptoms of concussion?

Answer 22

same as TBI

Question 23

How are concussions treated?

Answer 23

• should only last less than a week
• restart activity slowly
• should have no symptoms at rest before restarting activity