Head Trauma and Acute Intracranial Events Flashcards

1
Q

What is a cerebral contusion and what is the underlying pathology?

A

bruising of the brain tissue

blood mixes with the cortical tissue due to microhaemorrhages

associated with cerebral oedema

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2
Q

What is a contre-coup inury?

A

an injury that occurs on the side opposite to the area that was hit

coup - injury at the site that was hit

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3
Q

What is a concussion and what is the underlying pathology?

A

head injury associated with a temporay loss of brain function

caused by:

stretching/injury to axons > impairing neurtransmission

loss of ion regulation

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4
Q

Name 3 symptoms a patient with post-concussion syndrome may experience?

A
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5
Q

What is a diffuse axonal injury and what is the underlying pathology?

A

shearing of the interface between grey and white matter

usually due to rapid acceleration / deceleration

damage to intracerebral axons or dendritic connections

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6
Q

What clinical signs may a patient with basilar skull fracture present with?

A

Racoon Eyes
(periorbital ecchymosis)

CSF Rhinorrhoea

CSF Otorrhoea

Battles’ Sign

Haemotympanium

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7
Q

How can the GCS be used to stratify head injury severity?

A

Mild/Minor TBI:

GCS 13-15

Moderate TBI:

GCS 9-12

Severe TBI:

GCS <9

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8
Q

Which patients requrie an urgent CT scan of their head?

A
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9
Q

Outline the layers of the skull from skin to brain tissue

A

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

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10
Q

Between which layers in the head is a extradural haemorrage located and what is the common source of bleeding?

A

between the inner table of the skull and periosteal dural mater

middle meningeal artery

supratentorial in 95% of cases

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11
Q

How may a patient with an extradural haematoma present clinically

A

initial loss of consciousness

transient recover with ‘lucid’ period

raising ICP > decreasing level of consciousness

CN palsy as brain structures herniate

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12
Q

How can an extradural haematoma be managed?

A

craniotomy and clot evacuation

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13
Q

Between which layers does blood collect in a subdural haemorrhage?

A

collection between meningeal layer of dura mater and arachnoid mater (in potential space)

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14
Q

In which population are subdural haematomas most common and what is the most likely bleeding point?

A

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

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15
Q

How does the appearance of a subdural haemorrhage change over time?

A

initially HYPERDENSE

gradually becomes HYPODENSE
(darker than brain tissue)

haemorrhage is unable to cross the falx at the midline

(brighter than brain tissue)

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16
Q

How may an acute subdural haemorrhage be managed surgically and why?

A

Burr Hole / Craniotomy

need to relieve any increase in ICP

17
Q

Where does the blood collect in a subarachnoid haemorrhage?

A

blood collects between the arachnoid mater and pia mater

18
Q

What is the most common cause for a subarachnoid haemorrhage?

A

ruptured berry aneyrysm

19
Q

What signs and symptoms do patinets present with who have a subarachnoid haemorrhage?

A

Thunderclap Headache

Nausea and Vomiting

Focal Neurological Deficits

LOC

Meningism

20
Q

What are 3 risk factors for developing a berry aneurysm?

A

Hypertension

Family History

Abnormal Connective Tissue Disorder
(Ehlers-Danlos / Marfan’s Disease)

21
Q

How can berry aneurysms be treated if they are at a high risk of rupture?

A

surgical clipping

endovascular coiling

22
Q

What are the most common sites for aneurysm formation?

A

sites of bifurcation

(40% anterior cerebral artery)

23
Q

What findings on a lumbar puncture can be used to aid diagnosis of subarachnoid haemorrhage?

A

Presence of RBCs

  • *Xanthachromia**
  • (within 12 hours of Sx onset)*
24
Q
A