Head injury and hydrocephalus

Question 1

what are the admission criteria for head injuries?

Answer 1

• LoC
• headache or vomiting
• evidence of skull fracture or penetrating injury
• suspicion of non accidental injury
• significant medical problems
• social circumstances

Question 2

when do you need a CT scan of the brain within 1 hour?

Answer 2

• post-traumatic seizure
• GCS <14 on initial assessment (<15 if <1 year)
• GCS <15 2 hours after injury
• suspected skull fracture
• witnessed LoC
• amnesia (antegrade/ retrograde)
• abnormally drowsy
• > 3 episodes of vomiting
• dangerous mechanism of injury

Question 3

what is the common clinical presentation of someone with an extradural haemorrhage?

Answer 3

• “lucid interval” with an eventual LoC and raised ICP

- headache, vomiting,

Question 4

what is the clinical presentation of a subdural haemorrhage?

Answer 4

• fluctuations in consciousness
• physical/ intellectual slowing
• drowsiness
• headache/ personality change
• unsteadiness

Question 5

what is hydrocephalus?

Answer 5

• > volume of CSF occupying ventricles leading to dilatation
• CSF then leaks into ventricles causing damage and scarring

Question 6

what obstructive causes oh hydrocephalus are there?

Answer 6

• congenital malformation
• aqueduct stenosis (bickers adams)
• atresia of outflow foramina of 4th ventricle
• neoplasm
• vascular malformation
• intraventricular haemorrhage in preterm infant
• toxoplasmosis

Question 7

what non obstructive causes of hydrocephalus are there?

Answer 7

• subarachnoid haemorrhage
• meningitis
• increased CSF production

Question 8

how does the infant present in hydrocephalus?

Answer 8

• irritability, vomiting and impaired consciousness
• rapid increase in head circumference
• dilated scalp veins, tense fontanelle
• “setting sun sign” (retraction of upper lids, visible sclera)
• Macewens sign (Crack pot sound on percussion)

Question 9

what is cushings triad?

Answer 9

• bradycardia (vagus nerve parasympathetic)
• hypertension (vasomotor centre sympathetic response)
• respiratory depression

Question 10

how might hydrocephalus present in infants?

Answer 10

• headache and vomiting

- papilloedema and impaired upward gaze

Question 11

what is the management for hydrocephalus?

Answer 11

• LP can help if acute deterioration if communicating cause
• furosemide/ acetazolamide inhibit secretion of CSF by choroid
• ventriculotomy/ ventricoperitoneal shunt