Head Trauma Flashcards by Yash Patel

MC cause of mortality following trauma is

Head trauma

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Scalp laceration management in emergency cases

Apply pressure

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Scalp laceration definitive management

Suture; silk or nylons
Cutting or reverse cutting needle

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how does loose areolar tissue can cause cavernous sinus thrombosis ?

They contain emissary veins, which carry, retrograde infection

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Where is the dangerous area of face?

Lower part of the nose and upper lip. Any local infection in this area can spread retrograde to cause cavernous sinus thrombosis.

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In Anterior cranial fossa fracture there is fracture of

Cribriform plate

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Raccoon eyes / periorbital ecchymosis are associated with

Subaponeurotic bleeding(anterior cranial fossa)

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Black eyes are associated with

Subconjunctival hemorrhage

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What is target /halo sign

To differentiates CSF rhinorrhea from epistaxes. There will be a central circle of blood and outer circle of CSF.

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Which biochemical marker is seen in CSF?

β2 transferrin

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What is paradoxical rhinorrhea?

CSF accumulates in the middle year and travels down through eustachian tube and comes out through nasal cavity
Seen in middle cranial fossa fracture

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Middle cranial fossa fracture included

Fracture of petrous Part of temporal lobe

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Posterior cranial fossa fracture included

Fracture of occipital bone

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CF of posterior cranial fossa fracture

Visual problem
Occipital contusion
6th nerve injury(longest intracranial nerve)
Vernet syndrome

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What is vernet syndrome

Jugular foramen syndrome
(Injury to 9 th to 11th CN)

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What are the indications to involve a neurosurgeon?

• GCS <= 8.
• Fall in GCS after admission.
• Unexplained confusion > 4 hours.
• Loss of consciousness.
• Seizures.
• > I episode of vomiting.
•ENT bleed.
• Focal neurological signs.
• Penetrating CNS injury.

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Indications to carry out NCCT in head injury

• GCS < 13.
• If GCS fails to reach 15 within a hours of admission.
• Loss of consciousness.
• seizures.
• > I episode of vomiting.
• ENT bleed
• Focal neurological signs.
• Penetrating CNS injury.

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What to suspect if there is hypovolemic shock is present ?

Blood on floor ;;
Blood in the thorax , abdomen , pelvis , long bone fracture

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Colorado claudication for traumatic concussion

Concussion seen during contact sport .
Type 1: confusion ,
Type 2 : Amnesia ,
Type 3 : Loss of consciousness

Management of concussion.

Rest , Take a break from contact sports

What is Post concussion syndrome

Repeated concussions can cause personality/behavioral changes later on (Chronic traumatic encephalopathy)

Most severe type of brain injury is

Diffuse axonal injury (shearing force between grey and white matter)

HPE of diffuse axonal injury

Clubbed axons / retraction balls

What is the most common type of traumatic brain bleed

Contusion: Intraparenchymal hemorrhage

What is the most common site of Intraparenchymal hemorrhage

Temporal region > frontal region

Lucid interval is seen in

EDH ( not pathognomic)

IN EDH what is seen On NCCT

Biconvex / lens shaped appearance/ lentiform

Most common site where EDH occurs

Pterion

Indications for craniotomy in EDH

• > 30 cc clot size. • > 5 mm midline shift • > 1.5 cm thickness

When craniotomy is not available Burr hole / craniotomy is done at

On the side of the dilated pupil ( if there is no localizing sign best choice would be to do a butt hole in the dominant hemisphere, most commonly the left temporal region)

What is false localizing sign (Kernohan’s notch phenomenon )

* Left sided EDH -> Left dilated pupil * Temporal/uncal herniation on left side * Presses on the corticospinal tract of the right side (Kernohan's notch) * Left hemiparesis

Impacted vessels in EDH

MMA

Impacted vessels in SDH

Cortical bridging veins

What would you see on NCCT of patient presented with SDH

Concavo-convex / crescentic hemorrhage

What are the indications of craniotomy in SDH

• > I cm thickness. • > 5 mm midline shift. Any two out of these three • > 2 points GCS fall. • ICP > 20 mmHg. • Fixed dilated pupil. Extent of brain injury is more in SDH > EDH.

What is monro-kellie doctrine

States that the skull is a fixed space with components like brain, CSF, venous blood and arterial blood. The skull has tremendous capacity to compensate for an increasing mass or bleed ( by pushing out CSF or reducing venous volume), but once the point of decompensation is met, there can be rapid increase in ICP and hemiation.

CPP =

MAP-ICP CPP >=60 mmHg

Crushing reflex is described as

Bradycardia Hypertension Altered respiration

Cushing’s ulcer

Stress ulcer in head injury

Steroids used in

Vasogenic cerebral edema

Goal of treatment in head injury

Pulse oximetry > 95%. ICP : 20-25 mmg. CPP 2 60 mmHg. Glucose : 80- 180 mg/d. SBP >=100 mmHg.

Criteria of brain death

I. GCS = 3 2. Non reactive pupils. 3. Absent brainstem reflexes. 4. No spontaneous ventilatory effort. 5. Absence of confounding factors such as alcohol, drug intoxication or hypothermia

Glasgow outcome score

Prognostic score following head injury 1. Death. 2. Persistent vegetative state. 3. severe disability. 4. moderate disability. 5. Good recovery.

Which is the first reflects that you will expect to repair reappear after a spinal shock

Bulbocavernosus reflex

Causes of secondary brain injury

• Hypoxia • Hypotension • Raised ICP >20 mmHg • Low cerebral perfusion pressure • Hypercapnea • Hyperthermia • Seizures • Metabolic disturbance (hyperglycemia)