Head Trauma and Acute Intracranial Events Flashcards
What is a cerebral contusion and what is the underlying pathology?
bruising of the brain tissue
blood mixes with the cortical tissue due to microhaemorrhages
associated with cerebral oedema
What is a contre-coup inury?
an injury that occurs on the side opposite to the area that was hit
coup - injury at the site that was hit
What is a concussion and what is the underlying pathology?
head injury associated with a temporay loss of brain function
caused by:
stretching/injury to axons > impairing neurtransmission
loss of ion regulation
Name 3 symptoms a patient with post-concussion syndrome may experience?
What is a diffuse axonal injury and what is the underlying pathology?
shearing of the interface between grey and white matter
usually due to rapid acceleration / deceleration
damage to intracerebral axons or dendritic connections
What clinical signs may a patient with basilar skull fracture present with?
Racoon Eyes
(periorbital ecchymosis)
CSF Rhinorrhoea
CSF Otorrhoea
Battles’ Sign
Haemotympanium
How can the GCS be used to stratify head injury severity?
Mild/Minor TBI:
GCS 13-15
Moderate TBI:
GCS 9-12
Severe TBI:
GCS <9
Which patients requrie an urgent CT scan of their head?
Outline the layers of the skull from skin to brain tissue
Skin
Connective Tissue (dense)
Aponeurosis
Loose Connective Tissue
Perioteal Later
Outer Table > Diploeic Bone > Inner Table
Periosteal Dura
Meningeal Dura
Arachnoid Mater
Pia Mater
Brain Tissue
Between which layers in the head is a extradural haemorrage located and what is the common source of bleeding?
between the inner table of the skull and periosteal dural mater
middle meningeal artery
supratentorial in 95% of cases
How may a patient with an extradural haematoma present clinically
initial loss of consciousness
transient recover with ‘lucid’ period
raising ICP > decreasing level of consciousness
CN palsy as brain structures herniate
How can an extradural haematoma be managed?
craniotomy and clot evacuation
Between which layers does blood collect in a subdural haemorrhage?
collection between meningeal layer of dura mater and arachnoid mater (in potential space)
In which population are subdural haematomas most common and what is the most likely bleeding point?
more common in older population due to brain artophy
bridging veins are most likely bleeding point - which become stretched with brain atrophy > increased risk of shearing forces
How does the appearance of a subdural haemorrhage change over time?
initially HYPERDENSE
gradually becomes HYPODENSE
(darker than brain tissue)
haemorrhage is unable to cross the falx at the midline
(brighter than brain tissue)
How may an acute subdural haemorrhage be managed surgically and why?
Burr Hole / Craniotomy
need to relieve any increase in ICP
Where does the blood collect in a subarachnoid haemorrhage?
blood collects between the arachnoid mater and pia mater
What is the most common cause for a subarachnoid haemorrhage?
ruptured berry aneyrysm
What signs and symptoms do patinets present with who have a subarachnoid haemorrhage?
Thunderclap Headache
Nausea and Vomiting
Focal Neurological Deficits
LOC
Meningism
What are 3 risk factors for developing a berry aneurysm?
Hypertension
Family History
Abnormal Connective Tissue Disorder
(Ehlers-Danlos / Marfan’s Disease)
How can berry aneurysms be treated if they are at a high risk of rupture?
surgical clipping
endovascular coiling
What are the most common sites for aneurysm formation?
sites of bifurcation
(40% anterior cerebral artery)
What findings on a lumbar puncture can be used to aid diagnosis of subarachnoid haemorrhage?
Presence of RBCs
- *Xanthachromia**
- (within 12 hours of Sx onset)*
