Head Trauma Flashcards
What are the classifications of head injuries?
- Primary
- Secondary
What are primary head injuries?
Those that occur immediately after initial trauma
What are the types of primary head injuries?
- Focal
- Diffuse
What are focal head injuries?
Ones that occur in a specific place
What are diffuse head injuries?
Ones that occur throughout the brain
What are the types of focal head injuries?
- Haematoma
- Contusion
What are the types of haemotomas?
- Extradural
- Subdural
- Intracerebral
What can happen if you get a large enough contusion?
Can get intracranial haemorrhages and tears to the cranial nerves
Where can contusions occur?
- Site of impact (coup)
- Site opposite impact (contre-coup)
What are the types of diffuse head injuries?
- Concussion
- Diffuse axonal injury
What are the non-traumatic causes of head injury?
- Anoxia
- Infection
- CVA/TIA
Tumour - Metabolic disorder
What are the categories of traumatic head injuries?
- Open (penetrating)
- Closed (internal pressure and shearing)
What happens in penetrating head injuries?
Something pierces the skull and reaches the dura mater
What are the causes of open head injuries?
- Assault
- Fall
- Surgery
What are the causes of closed head injuries?
- Assault
- Falls
- Accidents
- Abuse
What is a cerebral contusion?
‘Bruising’ of the brain, whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks
How can a cerebral contusion occur directly under the impact?
If the brain hits a bony ridge
What is the most common site of cerebral contusions?
Anterior temporal lobe
What can happen over time with cerebral contusions?
Can develop and become complicated, can develop mass effects
What symptoms might arise with temporal and frontal lobe contusions?
Get attention, emotional, and memory problems
How can cerebral contusions lead to coma?
They can cause cerebral oedema or an intracerebral bleed, leading to raised ICP and therefore a coma
How can a cerebral contusion occur on the opposite side to impact?
The energy dissipates and causes brain to hit the opposite side of the skull.
The amount of energy that dissipates determines what contusion you get
What is concussion?
Head injury with temporal loss of brain function
Describe the pathophysiology of concussion?
Trauma leads to stretching and injury of axons, which leads to impaired neurotransmission, loss of ion regulation, and a reduction in cerebral blood flow, leading go temporary brain dysfunction
What do the symptoms of concussion depend on?
The site of injury
What symptoms might a frontal lobe concussion cause?
Problems with behaviour and memory
What problems might a temporal lobe concussion produce?
Problems with emotion and mood instability
What causes symptoms of concussion?
Believed to be a mixture of physical and psychological factors, including structural problems with the brain and neurotransmitter problems
What are the categories of symptoms of post-concussion syndrome?
- Thinking/remembering
- Physical
- Emotional/mood
- Sleep disturbances
What are the thinking/remembering symptoms of post-concussion syndrome?
- Difficulty thinking clearly
- Feeling slowed down
- Difficulty concentrating
- Difficulty remembering new information
What are the physical symptoms of post-concussion syndrome?
- Headache
- Nausea or vomiting
- Balance problems
- Dizziness
- Fuzzy or blurry vision
- Feeling tired, having no energy
- Sensitivity to noise or light
What are the emotional/mood symptoms of post-concussion syndrome?
- Irritability
- Sadness
- More emotinal
- Nervousness or anxiety
What are the potential sleep disturbances in post concussion syndromes?
- Sleeping more than usual
- Sleeping less than usual
- Trouble falling asleep
What is diffuse axonal injury?
Shearing of interface between grey and white matter following traumatic acceleration/deceleration, or rotational injuries to the brain damaging the intra-cerebral axons and dendritic connections
How can diffuse axonal injury cause coma?
Shearing of the grey and white matter interface can cause axonal death, which can cause cerebral oedema, leading to raised ICP then coma
What is a basilar skull fracture?
A bony fracture within the base of the skull
What bones form the base of the skull?
- Temporal
- Occipital
- Sphenoid
- Ethmoid
What needs to be considered when mananging basilar skull fractures?
A patient is not going to have an isolated basal skull fractures, they will also have other problems as it requires so much force
What does a basilar skull fracture cause?
Tears in the meninges, leading to CSF leakage
What are the clinical signs of basilar skull fractures?
- Raccoon eyes
- CSF rhinorrhoea
- CSF otorrhoea
- Battle sign
- Haemotympanum
- Bump
How are basilar skull fractures managed?
- Traumatic brain injury management, including ICP control
- Seek and treat complications
- Elevation of depressed skull fractures
- If there is persistent CSF leakage, surgery
What GCS indicates a mild head injury?
13-15
How long does post-traumatic amnesia last with mild head injury?
<1 day
How long does loss of consciousness last with mild head injury?
0-30 minutes
What GCS indicates a moderate head injury?
9-12
How long does post-traumatic amnesia last with moderate head injury?
>1 to <7 days
How long does loss of consciousness last with moderate head injury?
>30 min to <24 hours
What GCS indicates a severe head injury?
3-8
How long does post-traumatic amnesia last with severe head injury?
>7 days
How long does loss of consciousness last with severe head injury?
>24 hours
What is considered when determining if a patient needs an urgent head CT?
- Consciousness
- Neurological abnormality
- Suspected open/depressed skull fracture, or signs of a basal skull fracture
- 2+ discrete episodes of vomiting
What are the consciousness criteria for urgent head CT following injury?
- GCS <13 at any point
- GCS <14 more than 2 hours after injury
What neurological abnormalities indicate the need for an urgent head CT?
- Focal neurological deficit
- Seizure
- Loss of consiousness with any of;
- Age >65
- Coagulopathy
- Dangerous mechanism of injury
- Antegrade amnesia >30 minutes
