Head/Spinal Injuries & Raised ICP Flashcards
What are the two main types of traumatic brain injury?
Primary - as a result of brain trauma Secondary - develop later as a result of complications -hypoxia -ischaemia -haematomas
What are the common types of primary brain injuries?
Concussion
Diffuse axonal injury
Focal brain injuries
What is concussion?
Transient loss of consciousness w/ no persistent neurological signs
May be signs of neurological injury on CT
What are they key management features of diffuse axonal injury?
Visible on high res CT
Does not cause raised ICP
Treatment supportive
Can cause deficiencies in higher funcn
What are focal brain injuries?
Gross damage to localised areas of brain, visible on CT
These act as space-occupying lesions
What are the three types of focal brain injury?
Coup - beneath site of impact
Contre-coup - on opposite side of brain
Haemorrhage/haematoma
What is post-concussion syndrome?
Long term disability affecting 50% of those w/ a head injury
What are the sx of a post-concussion syndrome?
Dizziness Headache Poor concentration/memory Inability to work Difficulties w/ self care
What are the key components of assessing a pt w/ head injury?
C-spine precautions ABCDE resus Record GCS Hx/exam Imaging - CT head, C-spine radiography
What are the key signs of neurological deterioration?
Falling GCS (most important size) Changing pupillary size/responsiveness Focal neurological signs Changing resp rate Cushing's reflex
What is Cushing’s reflex?
Late sign of neurological deterioration, due to pressure on medulla
Falling pulse, rising BP
What pupillary changes are signs of neurological deterioration?
Initial progressive dilation on side of lesion and sluggish response to light
Due to pressure on oculmotor nn as ICP rises
If bilateral is pre-terminal
What is the effect of hypercapnia in head injury?
Cerebral vasodilation
Raises ICP
May need hyperventilation on ICU
What is the effect of hypoxaemia in head injury?
Cerebral vasodilation
Rapid lactic acidosis –> cerebral damage
What is the effect of hypotension in head injury?
Loss of autoregulation
Cerebral blood flow relies on SBP
Resus vital to maintain SBP
Which pts should have a head CT w/i 1hr of arrival?
GCS <13 at any time OR <15 2hrs post injury Focal neurological deficit Signs of increasing ICP Suspected skull fracture Post-traumatic seizure Vomiting >1 times
Which pts should have a head CT w/i 8hrs of arrival?
Anticoagulated pts Loss of consciousness AND -age >65 -dangerous mechanism of injury -retrograde amnesia >30mins
Which pts should be admitted following head injury?
If imaging shows pathology
GCS <15 (monitory every 30mins)
Continuing worrying signs/sources of concern
What is normal ICP?
0-10mmHg
What are the causes of increased ICP?
Vasogenic (tumour, trauma, ischaemia, infection)
Cytotoxic
Interstitial (obstructive hydrocephalus)
What are the sx of increasing ICP?
Headache - dull, persistent, worse on lying, present on waking, worse w/ coughing/straining
Vomiting
Seizures
Irritability
What are the signs of increasing ICP?
GCS deterioration
Progressive dilation of pupil on affected side
Cushing’s reflex
Cheyne-Stokes respiration
What is the management of raised ICP?
ABCDE Elevate head of bed to 30-40o Hyperventilate (reduce PaCO2) Mannitol (0.2g/kg 20% IV over 15 mins) Corticosteroids Fluid restriction Controlled hypothermia, CSF drainage, barbiturates
How long does Papilloedema take to develop?
Weeks
