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Neurology > Head trauma > Flashcards

Head trauma Flashcards

1
Q

What’s the difference between missile and non-missile head injury?

A

Missile: penetration of skull or brain

Non-missile: other, far more common

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2
Q

How can you classify head traumas by distribution?

A

Focal: local, in one site

Diffuse: widespread

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3
Q

What is the difference between primary and secondary damage in a head injury?

A

Primary: the immediate effects of the trauma

Secondary: the problems that present some time after the trauma, like infection, effects of hypoxia etc.

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4
Q

Name some types of focal brain damage?

A 
Lacerations
Contusions: bruises
Haemorrhage
Fracture
Infection
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5
Q

Name some types of diffuse brain damage?

A

Diffuse axonal injury
Diffuse vascular injury
Hypoxia - ischaemia
Swelling

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6
Q

What are the problems that a skull fracture can cause?

A

Haematoma + haemorrhage
Infection
Aerocele: pocket of air in the brain

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7
Q

Name the types of haemorrhage that can be caused by head injury?

A

Epidural

Subdural

Subarachnoid

Intracerebral
Cerebellar

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8
Q

What is a contusion?

A

A superficial bruise of brain

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9
Q

What is meant by:

  • coup
  • contre coup?
A

Coup: contusion at the site of the blow to the head

Contre-coup: contusion at other sites, due to the movement of the brain being out of sync with the skull after a blow to the head

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10
Q

What causes diffuse axonal injury?

A

Anything that could damage the axons

Ischaemia
Tumours
Demyelination (MS)
A blow to the head

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11
Q

What would you see on a CT of someone with diffuse vascular injuries?

A

Multiple petechial haemorrhages throughout the brain

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12
Q

Why is brain swelling bad?

A

Because the brain is kept inside a hard, unstretchable skull

If it swells intracranial pressure rises compressing the brain and damaging it

Or causing herniation, coning

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13
Q

What is herniation of the brain?

A

When swelling of the brain causes it to shift into places it shouldn’t

Like one hemisphere pushing over the midline

Or the brain pushing down onto brainstem (coning)

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14
Q

What two types of missile injury are there?

A

Penetrating: the bullet goes into skull and stops there

Perforating: the bullet goes into the skull and out the other side

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15
Q

What are the risks associated with penetrating injuries?

A

High risk of infection as bullet has made a track as it has embedded in the brain

Focal damage
Bleeding
Epilepsy

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16
Q

What is chronic traumatic encephalopathy (CTE)?

A

Progressive degenerative disease that affects people who have suffered from repetitive mild traumatic brain injury

17
Q

Who gets (CTE)?

A

Sports people

  • boxers
  • wrestlers
  • rugby
18
Q

Clinical features of CTE?

A

Disorientation
Dizziness
Headaches

Memory loss
Erratic behaviour

Progressive dementia
Slowing of muscular movements Tremors
Suicidality

19
Q

What is the Glasgow Coma Scale?

A

Measures level of consciousness of a patient

20
Q

What is the AVPU scale?

What does it stand for?

A

A quicker version of GCS, measures level of consciousness of patient more in an emergency setting

Alert
Voice (responds to)
Pain (responds to)
Unresponsive

21
Q

Why is it a good idea to ventilate an agitated patient with a head injury?

A

If they are agitated and stressed their blood pressure will be high
This will cause even more damage to the brain
It may raise ICP even more

They are better ventilated as then they are still and calm

22
Q

What does ICP stand for?

A

Intracranial pressure

23
Q

What is meant by ‘secondary head injury’?

A

Injury to the brain that results from another injury

Such as hypoxia of the brain or shock

24
Q

What does a mini neurological exam involve?

A

Glasgow coma scale score
Lateralising signs
Pupils

25
Q

What are lateralising signs?

A

Signs that help you to localise a CNS pathology

For example receptive dysphasia would indicate a lesion in the region of Wernicke’s area

26
Q

What drug should you give to someone as soon as you can after a head injury?

A

Mannitol a hyperosmotic agent

Sucks water out of the brain system, managing the swelling for a few hours

27
Q

What does Mannitol do?

A

Sucks water out of the brain system

Managing the swelling for a few hours

28
Q

What are Burr holes?

A

Hole drilled into the skull in which a tube is inserted through a hole to help drain the haematoma

29
Q

What is a craniotomy?

A

A section of the skull is temporarily removed so the surgeon can access and remove the haematoma

30
Q

What is a craniectomy?

A

Removal of part of the skull to relieve pressure in the cranium and allow the brain to swell

31
Q

Why do you need to be concerned about minor head injuries?

A

They are very common
About 2% of people with a minor head injury will develop complications

It is hard to know which ones!

32
Q

Which people with minor head injuries should you be extra concerned about?

A

Those on aspirin, warfarin

GCS score of 13-14

33
Q

What are some classic warning signs of a head injury that has progressed to something more severe?

A

Changes in level of consciousness

Seizures

Bleeding or watery discharge from ears or nose

34
Q

What is a basal skull fracture?

A

A fracture of the base of the skull

35
Q

What are some signs of a basal skull fracture?

A

Sub conjunctival haemorrhage

Bilateral periorbital haematoma: ‘Panda eyes’

Battle’s sign: bruising behind ears

Blood leaking from ears

36
Q

What is Battle’s sign?

A

Bruising behind the ear

37
Q

What complication can occur from a basal skull fracture?

A

Meningitis

38
Q

List some common pitfalls and things doctors miss in relation to head injuries?

A

Missed injury: like a neck injury or one obscured by hair

Not taking obs frequently enough

Loss of CSF via a leaking wound post craniotomy

Spinal reflexes mistaken for movement

Vertebral artery dissection

Neurology (23 decks)

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