Head Trauma Flashcards
MC cause of mortality following trauma is
Head trauma
Scalp laceration management in emergency cases
Apply pressure
Scalp laceration definitive management
Suture; silk or nylons
Cutting or reverse cutting needle
how does loose areolar tissue can cause cavernous sinus thrombosis ?
They contain emissary veins, which carry, retrograde infection
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. 
In Anterior cranial fossa fracture there is fracture of
Cribriform plate
Raccoon eyes / periorbital ecchymosis are associated with
Subaponeurotic bleeding(anterior cranial fossa)
Black eyes are associated with
Subconjunctival hemorrhage
What is target /halo sign
To differentiates CSF rhinorrhea from epistaxes. There will be a central circle of blood and outer circle of CSF. 
Which biochemical marker is seen in CSF?
β2 transferrin
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
Middle cranial fossa fracture included
Fracture of petrous Part of temporal lobe
Posterior cranial fossa fracture included
Fracture of occipital bone
CF of posterior cranial fossa fracture
Visual problem
Occipital contusion
6th nerve injury(longest intracranial nerve)
Vernet syndrome
What is vernet syndrome
Jugular foramen syndrome
(Injury to 9 th to 11th CN)
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.
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.
What to suspect if there is hypovolemic shock is present ?
Blood on floor ;;
Blood in the thorax , abdomen , pelvis , long bone fracture
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
- Death.
- Persistent vegetative state.
- severe disability.
- moderate disability.
- 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)
