Head Trauma 2

Question 1

What is a TIA?

Answer 1

TIA is the sudden onset of focal disturbance of brain function that lasts less than 24 hours and is of presumed vascular origin.

Question 2

What is the blood supply to the spinal cord?

Answer 2

• The anterior spinal artery supplies the anterior 2/3 of the spinal cord, which includes the motor area (the ventral horn)
• The posterior spinal artery supplies the dorsal columns
• There is also supply from the segmental arteries, which arise from the aorta and supply the nerve roots – there are 21 pairs.
• An artery responsible for the supply of much of the lower spine is the artery of Adamkiewicz, which can be damaged during aortic surgery.

Question 3

Where does the artery of Adamkiewcz arise? What does it supply? How can it damage and what does this cause?

Answer 3

o The artery of Adamkiewicz arises from around the 9th to 12th intercostal artery (from abdo aorta) and supplies the anterior spinal artery supplying the lower 2/3rds of the spinal cord.
o It can be damaged in aortic aneurysm repairs which lead to ischaemic damage to the lower 2/3rds of the spinal cord causing symptoms such as urinary and faecal incontinence.

Question 4

What is the most common form of spinal stroke? Causes?

Answer 4

The most common form of spinal stroke is occlusion of the anterior spinal artery (95%). This can be due to:

• Aortic disease – aneurysm, trauma, dissection, atherosclerosis
• Aortic surgery
• Vasculitis (such as giant cell arteritis)
• Sickle cell disease
• Hypotension
• Cardiac emboli
• Disc herniation

Question 5

How does spinal stroke present? What if there is fever?

Answer 5

It presents with acute onset symptoms, often accompanied by pain. The presence of fever is a red flag, suggesting bacterial meningitis, epidural or subdural abscess, granuloma or viral illness.

Question 6

What will be seen on examination?

Answer 6

Examination will demonstrate spinal shock initially (flaccid weakness, areflexia, anaesthesia). Often lose pain and temperature but preserve dorsal column modalities. After the period of spinal shock present with upper motor neuron signs.

Question 7

What are differentials for spinal shock?

Answer 7

•	Mass lesions
o	Tumour
o	Abscess
o	Granuloma
o	Haematoma
o	Disc herniation
•	Intraspinal haemorrhage
•	Acute inflammatory demyelinating polyneuropathy
o	Guillain-Barre syndrome
•	Demyelination, transverse myelitis
•	Sarcoidosis
•	TB
•	Syphilis

Question 8

What are the indications for CT head in head trauma?

Answer 8

• They should have a CT head within one hour if:
o Their GCS<13 on initial assessment in ED
o Their GCS<15 2 hours after the injury
o They are suspected to have an open or depressed skull facture
o They have any signs of basal skull fracture
o They have post traumatic seizure
o There is a focal neurological deficit
o They vomit more than once
• They should have a CT head within 8 hours if:
o They are over 65
o They have a history of bleeding or clotting disorders
o There was a dangerous mechanism of injury
o There is more than 30 minutes of retrograde amnesia of events immediately before the injury