Head Trauma

Question 1

How do you calculate the CPP and what are your targets?

Answer 1

CPP= MAP - ICP
map target 80
ICP target <15
Ideal CPP > 60

Question 2

3 components of Cushing reflex

Answer 2

Hypertension bradycardia and irregular respirations

Question 3

Describes decorticate posturing and the level of injury it implies

Answer 3

Flexion upper extremities, extension lower extremities

Injury to corticospinal tract above brainstem

Question 4

Describe decerebrate posturing and what injury it implies

Answer 4

Extension arms and legs with flexion hands feet toes

Injury to brainstem

Question 5

2 maneuvers to test brainstem function

Answer 5

Oculocephalic and oculovestibular

Question 6

Clinical findings of uncal herniation syndrome

Answer 6

Non reactive dilated ipsilateral pupil
Pupil down and out
Contralateral hemiparesis

Question 7

8 management steps in elevated ICP patient

Answer 7

Intubate with RSI
elevate head of bed to 30 degrees
Avoid hypotension (SBP>90)
Hyperosmotic agents (mannitol 1g/kg or hypertonic saline 150 cc)
Relative hyperventilation 35-40 CO2 target as temporizing measure
Reverse anticoagulation
Seizure prophylaxis (careful in tox trauma)
Antibiotics for penetrating injuries

Question 8

Epidural hematoma: 
CT findings
anatomical location of space
culprit vessel
Management

Answer 8

Biconvex lens shape, does not cross suture lines
Potential space between skull and dura
Temporal skull fracture and middle meninges artery tear
Surgical emergency needs drainage stat
Less common in elderly

Question 9

Subdural hematoma:
CT findings 
Anatomical location 
Culprit vessels
Management

Answer 9

Crescent shaped, crosses suture lines
Between dura and arachnoid mater
Bridging veins
Management depends on acuity and extent 
Consider in alcoholics and elderly (more space for shearing of bridging veins)

Question 10

Subarachnoid hemorrhage:
CT findings 
Anatomical location 
Culprit vessels
Management

Answer 10

Blood in ventricles, basilar cistern, hemispheric sulci and fissures
Subarachnoid space
Subarachnoid vessels
Neurosurgical consult for ?surgical management. Nimodipine is for spontaneous aneurysm rupture not traumatic SAH

Question 11

5 bones of skull base

Answer 11

Frontal
Occipital
Temporal
Ethmoid (cribiform plate)
Sphenoid

Question 12

6 signs and 2 symptoms basal skull fracture

Answer 12

Vertigo
Hearing loss
Hemotympanum 
Battle sign 
Raccoon eyes
Csf leak -- otorrhea
Csf leak -- rhinorrhea

Question 13

Imaging study of choice, management for most, complication of basal skull fracture

Answer 13

Ct head, most conservative management, meningitis (role for prophylactic antibiotics controversial)

Question 14

3 descriptors of skull fractures

Answer 14

Comminuted, linear, depressed

Question 15

When is operative repair indicated in skull fractures

Answer 15

More than one full thickness of skull– risk of brain compression

Question 16

Types of skull fractures suggesting child abuse

Answer 16

Crossing suture lines
Multiple eggshell fractures
Occipital impression fractures