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ESA 5 - Nervous System > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

What are the classifications of head injuries?

A
  • Primary
  • Secondary
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2
Q

What are primary head injuries?

A

Those that occur immediately after initial trauma

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3
Q

What are the types of primary head injuries?

A
  • Focal
  • Diffuse
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4
Q

What are focal head injuries?

A

Ones that occur in a specific place

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5
Q

What are diffuse head injuries?

A

Ones that occur throughout the brain

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6
Q

What are the types of focal head injuries?

A
  • Haematoma
  • Contusion
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7
Q

What are the types of haemotomas?

A
  • Extradural
  • Subdural
  • Intracerebral
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8
Q

What can happen if you get a large enough contusion?

A

Can get intracranial haemorrhages and tears to the cranial nerves

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9
Q

Where can contusions occur?

A
  • Site of impact (coup)
  • Site opposite impact (contre-coup)
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10
Q

What are the types of diffuse head injuries?

A
  • Concussion
  • Diffuse axonal injury
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11
Q

What are the non-traumatic causes of head injury?

A
  • Anoxia
  • Infection
  • CVA/TIA
    Tumour
  • Metabolic disorder
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12
Q

What are the categories of traumatic head injuries?

A
  • Open (penetrating)
  • Closed (internal pressure and shearing)
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13
Q

What happens in penetrating head injuries?

A

Something pierces the skull and reaches the dura mater

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14
Q

What are the causes of open head injuries?

A
  • Assault
  • Fall
  • Surgery
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15
Q

What are the causes of closed head injuries?

A
  • Assault
  • Falls
  • Accidents
  • Abuse
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16
Q

What is a cerebral contusion?

A

‘Bruising’ of the brain, whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks

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17
Q

How can a cerebral contusion occur directly under the impact?

A

If the brain hits a bony ridge

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18
Q

What is the most common site of cerebral contusions?

A

Anterior temporal lobe

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19
Q

What can happen over time with cerebral contusions?

A

Can develop and become complicated, can develop mass effects

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20
Q

What symptoms might arise with temporal and frontal lobe contusions?

A

Get attention, emotional, and memory problems

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21
Q

How can cerebral contusions lead to coma?

A

They can cause cerebral oedema or an intracerebral bleed, leading to raised ICP and therefore a coma

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22
Q

How can a cerebral contusion occur on the opposite side to impact?

A

The energy dissipates and causes brain to hit the opposite side of the skull.

The amount of energy that dissipates determines what contusion you get

23
Q

What is concussion?

A

Head injury with temporal loss of brain function

24
Q

Describe the pathophysiology of concussion?

A

Trauma leads to stretching and injury of axons, which leads to impaired neurotransmission, loss of ion regulation, and a reduction in cerebral blood flow, leading go temporary brain dysfunction

25
Q

What do the symptoms of concussion depend on?

A

The site of injury

26
Q

What symptoms might a frontal lobe concussion cause?

A

Problems with behaviour and memory

27
Q

What problems might a temporal lobe concussion produce?

A

Problems with emotion and mood instability

28
Q

What causes symptoms of concussion?

A

Believed to be a mixture of physical and psychological factors, including structural problems with the brain and neurotransmitter problems

29
Q

What are the categories of symptoms of post-concussion syndrome?

A
  • Thinking/remembering
  • Physical
  • Emotional/mood
  • Sleep disturbances
30
Q

What are the thinking/remembering symptoms of post-concussion syndrome?

A
  • Difficulty thinking clearly
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering new information
31
Q

What are the physical symptoms of post-concussion syndrome?

A
  • Headache
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Fuzzy or blurry vision
  • Feeling tired, having no energy
  • Sensitivity to noise or light
32
Q

What are the emotional/mood symptoms of post-concussion syndrome?

A
  • Irritability
  • Sadness
  • More emotinal
  • Nervousness or anxiety
33
Q

What are the potential sleep disturbances in post concussion syndromes?

A
  • Sleeping more than usual
  • Sleeping less than usual
  • Trouble falling asleep
34
Q

What is diffuse axonal injury?

A

Shearing of interface between grey and white matter following traumatic acceleration/deceleration, or rotational injuries to the brain damaging the intra-cerebral axons and dendritic connections

35
Q

How can diffuse axonal injury cause coma?

A

Shearing of the grey and white matter interface can cause axonal death, which can cause cerebral oedema, leading to raised ICP then coma

36
Q

What is a basilar skull fracture?

A

A bony fracture within the base of the skull

37
Q

What bones form the base of the skull?

A
  • Temporal
  • Occipital
  • Sphenoid
  • Ethmoid
38
Q

What needs to be considered when mananging basilar skull fractures?

A

A patient is not going to have an isolated basal skull fractures, they will also have other problems as it requires so much force

39
Q

What does a basilar skull fracture cause?

A

Tears in the meninges, leading to CSF leakage

40
Q

What are the clinical signs of basilar skull fractures?

A
  • Raccoon eyes
  • CSF rhinorrhoea
  • CSF otorrhoea
  • Battle sign
  • Haemotympanum
  • Bump
41
Q

How are basilar skull fractures managed?

A
  • Traumatic brain injury management, including ICP control
  • Seek and treat complications
  • Elevation of depressed skull fractures
  • If there is persistent CSF leakage, surgery
42
Q

What GCS indicates a mild head injury?

A

13-15

43
Q

How long does post-traumatic amnesia last with mild head injury?

A

<1 day

44
Q

How long does loss of consciousness last with mild head injury?

A

0-30 minutes

45
Q

What GCS indicates a moderate head injury?

A

9-12

46
Q

How long does post-traumatic amnesia last with moderate head injury?

A

>1 to <7 days

47
Q

How long does loss of consciousness last with moderate head injury?

A

>30 min to <24 hours

48
Q

What GCS indicates a severe head injury?

A

3-8

49
Q

How long does post-traumatic amnesia last with severe head injury?

A

>7 days

50
Q

How long does loss of consciousness last with severe head injury?

A

>24 hours

51
Q

What is considered when determining if a patient needs an urgent head CT?

A
  • Consciousness
  • Neurological abnormality
  • Suspected open/depressed skull fracture, or signs of a basal skull fracture
  • 2+ discrete episodes of vomiting
52
Q

What are the consciousness criteria for urgent head CT following injury?

A
  • GCS <13 at any point
  • GCS <14 more than 2 hours after injury
53
Q

What neurological abnormalities indicate the need for an urgent head CT?

A
  • Focal neurological deficit
  • Seizure
  • Loss of consiousness with any of;
    • Age >65
    • Coagulopathy
    • Dangerous mechanism of injury
    • Antegrade amnesia >30 minutes

ESA 5 - Nervous System (18 decks)

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