Head Trauma and Acute Intracranial Events

Question 1

How can head trauma be classified?

Answer 1

Primary = focal, diffuse

Secondary = complication (worsening primary)

Question 2

Define cerebral contusion

Answer 2

Bruising” of brain whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks.

Question 3

Outline the pathophysiology of a cerebral contusion

Answer 3

Trauma –> Microhaemorrhages –>Cerebral contusion –> Cerebral oedema/Intracerebral bleed –> Raised ICP –> Coma

Question 4

Define coup

Answer 4

blow – area of direct impact

Question 5

Define contra-coup

Answer 5

counter blow = contusion on contra-side of the impact

Question 6

What is concussion?

Answer 6

Head injury with a temporary loss of brain function

Question 7

Outline the pathophysiology of concussion

Answer 7

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

Question 8

Discuss post concussion syndrome

Answer 8

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

Question 9

Define diffuse axonal injury

Answer 9

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.

Question 10

Outline the pathophysiology of diffuse axonal injury

Answer 10

Trauma –> shearing of grey and white matter interface –> axonal death –> cerebral oedema –> raised ICP –> Coma

Question 11

Discuss a basilar skull fracture

Answer 11

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

Question 12

What indications warrant a CT head?

Answer 12

Consciousness <13

Seizure

Focal neurological deficit

Suspected skull fracture

2+ discrete episodes of vomiting

Question 13

Discuss an extradural haemorrhage

Answer 13

Between inner surface of skull and periosteal dura mater

Mainly secondary to trauma

Middle meningeal A

CT = Lens/biconvex, midline shift, compressed ventricles

Question 14

How do pts with extradural haemorrhage present?

Answer 14

Loss on consciousness due to impact of initial injury

Transient recovery

Ongoing headache

Cranial N palsies

Question 15

How are extra dural haemorrhages managed?

Answer 15

Urgent craniotomy to relieve RICP

Observe if small EDH

Question 16

Discuss a subdural haemorrhage

Answer 16

Between meningeal dura mater and arachnoid mater

Most often trauma but can be spontaneous

Bridging veins

CT = banana/sickle, midline shift, compressed ventricles, loss of sulci, doesn’t cross midline due to falx cerebri. Acute = white. Chronic = dark

Question 17

How are subdural haemorrhages managed?

Answer 17

Acute need immediate neurosurgical intervention to relieve RICP

Burr hole

Craniotomy

Question 18

Discuss a subarachnoid

Answer 18

Between arachnoid and pia mater

Usually occur spontaneously – ruptured berry aneurysm (mainly found in the anterior cerebral circulation)

Middle aged group 40-60

CT = focal areas, white basal cisterns

Fills basal cisterns with blood

Question 19

How does a subarachnoid haemorrhage present?

Answer 19

Sudden onset ‘thunderclap’ headache

Meningism

N+V

Fever

Focal neurological deficits

LOC

Question 20

How are subarachnoid haemorrhages managed?

Answer 20

ITU

Prevent rebleeding

Treat cerebral vasospasm