Head Trauma

Question 1

What are the classifications of head injuries

Answer 1

By injury processes:
Primary
Secondary

By cause:
Traumatic
Non-traumatic

Question 2

What are possible causes of brain injury

Answer 2

Traumatic: fall, assault, accidents, surgery

Non-traumatic: anoxia, infection, stroke, tumour, metabolic

Question 3

What are the types of primary brain injury

Answer 3

Focal:
Contusion
Haemorrhage

Diffuse:
Concussion
Diffuse axonal injury

Question 4

What is contusion

Answer 4

Bruising of brain due to leakage of blood from small vessels into cortical tissue

Question 5

What are the types of contusion

Answer 5

Coup: damage at site of impact

Contre-coup: damage at site opposite impact

Question 6

What are the common sites of contusion

Answer 6

Anterior part of Frontal lobe

Inferior part of temporal lobe

Question 7

What are primary and secondary brain injuries

Answer 7

Primary: brain injury due to direct effects of insult - mechanical damage

Secondary: brain injury due to indirect effects of insult - processes initiated by insult

Question 8

What is the pathophysiology of contusion

Answer 8

Microhaemorrhage

Question 9

What are secondary injuries involved in contusion

Answer 9

Oedema

Raised ICP

Question 10

What is concussion

Answer 10

Type of traumatic brain injury with temporary loss of brain function

Question 11

What is the pathophysiology of concussion

Answer 11

Stretching of neurones causing:
Impaired neurotransmission
Loss of Ion regulation

Question 12

What are the features of post-concussion syndrome

Answer 12

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

Question 13

What is diffuse axonal injury

Answer 13

Type of traumatic brain injury involving shearing of axons at white-grey matter interface due to sudden acceleration/deceleration/rotational forces

Question 14

What is the pathophysiology of diffuse axonal injury

Answer 14

Shearing at white-grey interface causing axonal death

Question 15

What are secondary injuries in diffuse axonal injury

Answer 15

Oedema
RICP 
Coma
Persistent vegetative state
Death

Question 16

What is basilar skull fracture

Answer 16

Fracture of bones of base of skull:

Frontal, sphenoid, ethmoid, temporal, occipital

Question 17

What are the features of basilar skull fracture

Answer 17

Raccoon eyes (periorbital ecchymosis) 
Battles sign (bruising over mastoid process) 
CSF rhinorrhoea
CSF otorrhoea
Haemotympanum
Scalp haematoma

Question 18

How do you assess severity of traumatic head injury

Answer 18

GCS
Post-traumatic amnesia
Length of LOC

Question 19

What are the criteria for mild head injury

Answer 19

GCS 13-15
Amnesia <1 day
LOC 0-30mins

Question 20

What are the criteria for moderate head injury

Answer 20

GCS 9-12
Amnesia 1-7 days
LOC 30m-24 hrs

Question 21

What are the criteria for severe head injury

Answer 21

GCS 3-8
Amnesia >7 days
LOC >24 hours

Question 22

What is the imaging modality of choice for head injury

Answer 22

CT (in emergency setting)

Question 23

What are the criteria for CT Head within 3 hours of presentation

Answer 23

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