Head Trauma and Acute Intracranial Events Flashcards
How can head trauma be classified?
Primary = focal, diffuse
Secondary = complication (worsening primary)
Define cerebral contusion
Bruising” of brain whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks.
Outline the pathophysiology of a cerebral contusion
Trauma –> Microhaemorrhages –>Cerebral contusion –> Cerebral oedema/Intracerebral bleed –> Raised ICP –> Coma
Define coup
blow – area of direct impact
Define contra-coup
counter blow = contusion on contra-side of the impact
What is concussion?
Head injury with a temporary loss of brain function
Outline the pathophysiology of concussion
Trauma –> Stretching and injury to axons –> impaired neurotransmission, loss of ion regulation, and a reduction in cerebral blood flow –> Temporary brain dysfunction
Damage to the reticular activating system = lose consciousness
Discuss post concussion syndrome
Set of symptoms that can continue after the event
= diff thinking clearly, diff remembering new info, headaches, dizziness, sadness, anxiety, trouble falling asleep
Physical and phycological factors contribute to it
Define diffuse axonal injury
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.
Outline the pathophysiology of diffuse axonal injury
Trauma –> shearing of grey and white matter interface –> axonal death –> cerebral oedema –> raised ICP –> Coma
Discuss a basilar skull fracture
Bony fracture within the base of skull (temporal, occipital, sphenoid, or ethmoid bone)
Pathophysiology = Trauma –> tears in the meninges –> CSF leakage.
Identify secondary injuries
Signs = raccoon eyes, CSF rhinorrhea, CSF otorrhea, battle sign, haemotympanum, bump
Management = elevation of depressed skull, CSF leak management, surgery, ICP control
What indications warrant a CT head?
Consciousness <13
Seizure
Focal neurological deficit
Suspected skull fracture
2+ discrete episodes of vomiting
Discuss an extradural haemorrhage
Between inner surface of skull and periosteal dura mater
Mainly secondary to trauma
Middle meningeal A
CT = Lens/biconvex, midline shift, compressed ventricles
How do pts with extradural haemorrhage present?
Loss on consciousness due to impact of initial injury
Transient recovery
Ongoing headache
Cranial N palsies
How are extra dural haemorrhages managed?
Urgent craniotomy to relieve RICP
Observe if small EDH
