Head Trauma Flashcards
What are the classifications of head injuries
By injury processes:
Primary
Secondary
By cause:
Traumatic
Non-traumatic
What are possible causes of brain injury
Traumatic: fall, assault, accidents, surgery
Non-traumatic: anoxia, infection, stroke, tumour, metabolic
What are the types of primary brain injury
Focal:
Contusion
Haemorrhage
Diffuse:
Concussion
Diffuse axonal injury
What is contusion
Bruising of brain due to leakage of blood from small vessels into cortical tissue
What are the types of contusion
Coup: damage at site of impact
Contre-coup: damage at site opposite impact
What are the common sites of contusion
Anterior part of Frontal lobe
Inferior part of temporal lobe
What are primary and secondary brain injuries
Primary: brain injury due to direct effects of insult - mechanical damage
Secondary: brain injury due to indirect effects of insult - processes initiated by insult
What is the pathophysiology of contusion
Microhaemorrhage
What are secondary injuries involved in contusion
Oedema
Raised ICP
What is concussion
Type of traumatic brain injury with temporary loss of brain function
What is the pathophysiology of concussion
Stretching of neurones causing:
Impaired neurotransmission
Loss of Ion regulation
What are the features of post-concussion syndrome
Cognitive: difficulty concentrating, remembering new information, thinking clearly
Physical: headache, N+V, dizziness, blurry vision, sensitivity to light/smell, tiredness
Psychological: irritability, sadness, anxiety
Sleep disturbance: increased, decreased, difficulty falling asleep
What is diffuse axonal injury
Type of traumatic brain injury involving shearing of axons at white-grey matter interface due to sudden acceleration/deceleration/rotational forces
What is the pathophysiology of diffuse axonal injury
Shearing at white-grey interface causing axonal death
What are secondary injuries in diffuse axonal injury
Oedema RICP Coma Persistent vegetative state Death
What is basilar skull fracture
Fracture of bones of base of skull:
Frontal, sphenoid, ethmoid, temporal, occipital
What are the features of basilar skull fracture
Raccoon eyes (periorbital ecchymosis) Battles sign (bruising over mastoid process) CSF rhinorrhoea CSF otorrhoea Haemotympanum Scalp haematoma
How do you assess severity of traumatic head injury
GCS
Post-traumatic amnesia
Length of LOC
What are the criteria for mild head injury
GCS 13-15
Amnesia <1 day
LOC 0-30mins
What are the criteria for moderate head injury
GCS 9-12
Amnesia 1-7 days
LOC 30m-24 hrs
What are the criteria for severe head injury
GCS 3-8
Amnesia >7 days
LOC >24 hours
What is the imaging modality of choice for head injury
CT (in emergency setting)
What are the criteria for CT Head within 3 hours of presentation
Consciousness level:
GCS <13 at any point
GCS <14 2 hours after injury
Neurological:
Focal neurological signs
Seizure
LOC with - age >65, coagulopathy, anterograde amnesia >30 mins
Other:
Suspected basilar skull fracture
2+ episodes of vomiting
