Head Trauma

Question 1

Normal ICP and raised ICP pressure

Answer 1

Normal 10mmHg
>20mmHg = poor outcome

Question 2

Signs suggestive of cranial and intracranial injury

Answer 2

Facial fracture of midface w instability of maxilla or orbital complex
Auditory canal haemorrhage
Temporal bone fracture - middle meningeal
Retroauricular ecchymosis (Battle’s sign)

Asymmetric non-reactive pupil
-> lateralising sign of ICB or direct injury to third cranial nerve

Scalp laceration

Question 3

Epidural haematoma: Location, affected artery, typical presentation and CTH finding

Answer 3

Temporal or temporoparietal
Middle meningeal tear from fracture
Arterial clots

Lucid interval between injury and deterioration bc LOC from intial impact, then gradual bleeding until compressing brain enough to drop GCS

Cone shape on CT

Question 4

Subdural hematoma: injury, typical presentation and CTH finding

Answer 4

Shearing of blood vessels in cortex
Banana shaped covering cerebral surface

Repeat CT monitoring

Question 5

Contusion: Location, typical presentation

Answer 5

Frontal, temporal
Can evolve to for intracerebral haematoma e.g. subgalaeal

Question 6

Pathophysiology of uncal herniation and its signs

Answer 6

Compression of parasympathetic fibres of oculomotor nerve III = unopposed sympathetic actvity = blown pupil
Down and out - 4th and 6th nerve

Compression of corticospinal tract in midbrain which crosses over at the foramen magnum = contralateral hemiparesis

Reduced GCS from compression of reticular activating system

Question 7

CT findings that indicate severe HI and thus neurosurgical intervention

Answer 7

Midline shift > 5mm
Loss of basal cistern
Skull fracture with intrusion ito brain matter

Question 8

TBI Mx

Answer 8

IVI
Correct anticoagulation
Hypertonic saline 3%
Mannitol
Barbituates
- > Inital phase Phenytoin 1g IV loading over 20 mins minimum
Decrease agitation with sedation - short-acting

Question 9

Therapy in elderly to consider when treating for TBI

Answer 9

Antiplatelet
Anticoagulation
BB
Pacemaker
Stent insertion

Question 10

Target pCO2 in TBI

Answer 10

35mmHg/4.7kPa = lower end of normal, low = vasoconstriction, high = vasodilation = raised ICP

Question 11

Target O2 sats in TBI

Answer 11

98%, administer 100% oxygen

Question 12

Mannitol dosing for raised ICP e.g. herniation or oedema

Answer 12

1g/kg over 5 mins

contraindicated in hypotension

Question 13

When to repeat CT within 24h

Answer 13

Frontal temporal contusion
Anticoagulated
>65
ICB vol >10ml

Question 14

Reversal agent for Heparin

Answer 14

Protamine