Head Trauma And Acute Intracranial Events

Question 1

What is a secondary head injury?

Answer 1

Is a complication of a worsening primary head injury

Question 2

What are the forms of focal head injury?

Answer 2

Heamotomas, including extradural, subdural and intracerebral

Question 3

What are some of the diffuse forms of a primary head injury?

Answer 3

Concussion and diffuse axonal injury

Question 4

What is a cerebral contusion?

Answer 4

A bruising of the brain whereby blood mixes with cortical tissue due to mircohaemorrages and small blood vessel leaks

Question 5

What is the difference between a croup and a contre croup!

Answer 5

A croup is found at the site of impact whereas a contracrop is found at the other side of the head

Question 6

What is the pathological proccess through which you develop a contusion?

Answer 6

Trauma, mircohaemorrages, and then cerebral contusion leading to a cerebral oedema or a intracerebral bleed, a raised ICP and then a coma

Question 7

What is a concussion?

Answer 7

A head injury with a temporary loss of brain function

Question 8

What is the pathophysiology of a concussion?

Answer 8

Trauma leading to stretching and injury to axons, leading to impaired neural transmission, a loss in ion regulration, and a reduction in cerebral blood flow, and this leads to a temporary brain dysfunction

Question 9

What are some of the symptoms of a post concussion syndrome?

Answer 9

Headache, dizziness and cognitive difficulties, thinking issues incuding a feeling of being slowed down, physical issues including balance oroblems, dizziness and fuzzy or blurry vision, and emotional and mood problems including sadness, irritability, more emotional.

Question 10

What is a diffuse axonal injury?

Answer 10

This is a stretching of the itnerface between white and grey matter, following traumatic accelaration of decelearation or rotational injuries to the brain, damaging the intra cerebral axons and dendretic connections

Question 11

What is the pathophysiology of a diffuse axonal injury?

Answer 11

Trauma, leading to a shearing of grey and white matter, leading to axonal death, cerebral odema, raised ICP and then coma

Question 12

What is a basiliar skull fracture and name some of the bones involved?

Answer 12

This is a bony fracture of the base of the skull, and involves the temporal, occipital, ethmoid and the spenoid bones

Question 13

What are some of the clinical features of a basiliar skull fracture?

Answer 13

Racoon eyes or a periorbital heamotoma, haemotympanium or blood seen in the middle ear vavity, CSF rhinnorhea, is the dura near the paranasal sinuses is preache, and CSF ottorhea

Question 14

What are some of the features of the management of a basiliar skull fracture?

Answer 14

Management of the traumatic brian injury including the ICP control, seek and treat complicaitons, peresistant csf leak management including surgery and the elevation of the depressed skull tissue

Question 15

When may a glasgow coma scale score be falsely reduced?

Answer 15

Shock, hyponatremia, intoxication and sedative drug administration

Question 16

What would be some of the features of a mild head injury?

Answer 16

A GCS of 13-15, post traumatic amnesia of less than 1 day and loss of conciousness for 0-30 minutes

Question 17

What are some of the features of a moderate head injuy?

Answer 17

A GCS score of 9-12, post traumatic amnesia of between 1-7 days and a loss of conciousness between 30 minutes and 24 hours

Question 18

What are some of the features of a severe head injury?

Answer 18

A GCS of between 3-8, a post traumatic amnesia of less than 7 days and a loss of conciousness of less than 24 hours

Question 19

What are some of the criteria for a urgent CT head scan?

Answer 19

A GCS of less than 13 at any point or less than 14 more than 2 hours after injury, a neurological abnormality such as a focal neurological defecit or seziure, or loss of conciousness with any of an age greater than 65, antergrade amnesia of more than 30 minutes, a dangerous method of injury or a cogulopathy

Question 20

How would a extradural heamorrage appear on a ct scan?

Answer 20

Lemon shaped (convex or lentiform), there may be midline shift and compressed ventricles

Question 21

What is an extradural heamotoma?

Answer 21

A collection of bloof between the inner surface of the skull and the periosteal dura mater

Question 22

When might a extradural heamorage occur?

Answer 22

Secondary to a trauma or a skull fracture

Question 23

Which group are more likely to experience extradural heamtoma

Answer 23

Younger paitents, espeically as a result of sport

Question 24

What is the location of a extradural heamtoma?

Answer 24

Supertentorial in 95% if cases

Question 25

What is the most common cause of an extradural hemaorrage?

Answer 25

A bleed in 95% of cases from a severed artery, paticulary the middle menigeal but also may be the result of a torn venous sinus

Question 26

How may a paitent present with a extradural heamorrhage?

Answer 26

They will have experienced loss of conciousness due to impact of intial injury, and then a lucid interval where the paitent experiences a transient recovery with a ongoing headahce,

Question 27

What is the pathophysiology of a extradural heamotoma?

Answer 27

The heamotoma enlarges, there is a ICP increase, and then there is brain compression a rapid deteriation in conciousness

Question 28

Why may you see cranial nerve palsies in a extradural heamotoma?

Answer 28

As brain structures start to herniate

Question 29

How would you manage a extradural heamtoma?

Answer 29

A small edh can be oberseved and managed conservativelg with a neurologicla follow il, a large one is treated using a craniotomy and a clot evacuation

Question 30

What may be some of the complications of an EDH?

Answer 30

Permeanat brain damage, coma, seizures, ateriovenous fistual, pseudoanyersum, weakness

Question 31

What is a subdural heamorrhage?

Answer 31

A collection of blood between the menigeal dura mater and the arachoid mater

Question 32

What are the different types of subdural heamorrhage?

Answer 32

The different types reger to the time between sustaining bleed and the presentation
Acute is less than 3 days
Subacute is 3-21 days
Chronic is greater than 3 weeks

Question 33

Why might the bleeding occur in a subdural heamotoma?

Answer 33

Bleeding is most often assoicated with trauma but may be spintaneous, either due to shearing forces or the rupture of cortical bridging veins

Question 34

How might a subdural heamtoma appear on a ct scan?

Answer 34

With a banna shape and compression with the loss of sulci and gyri

Question 35

What are some of the presenting features of an a ute sdh?

Answer 35

Seen in the setting of head trauma, and will appear with neurological abnormalities, and will be hyperdense on ct scan but will gradually become more hypodense with time

Question 36

What are some of the presenting features of a subacute or chronic sdh?

Answer 36

Common in elderly, will presention with a insidious onset of confusion or general cognitive decline that is similar to dementia, may also be a result of small subdural heamorrages that acculamuate over time

Question 37

How would you manage a small chronic subdural heamotoma?

Answer 37

These are evaluated using serial imagin

Question 38

How would tou manage a acute subdurla heamotoma?

Answer 38

Immediate reffereal to neurosurgery for interventions

Question 39

How would you manage a symptomatic acute or subactue sdh?

Answer 39

Can be managed using burr holes

Question 40

What is a subarachoid heamorrage?

Answer 40

An acculumation of blood between the arachoid and pia mater

Question 41

What group of paitents usually present with a subarachoid heamorrage?

Answer 41

Middle aged paitents who are younger than 60

Question 42

What is the presentation of a subarachoid haemoorhage?

Answer 42

A sudden onset thunderclap headached, focal neurological defects, mennigism, nausea and vomiting, a fever and a loss of conciousness

Question 43

How due to the vast majority of subarachoid heamorrhages develop?

Answer 43

Spontaneohsly, usually after the ruputre of a berry anyersum

Question 44

What are some of the risk factors for development of a berry anyersum?

Answer 44

Hypertension, family hsitory, heavy alchol consumption, and disesaes that create abnormal connective tissue such as elhers danos syndrome

Question 45

What can be done if the risk of rupture of a berry anyresum is high p?

Answer 45

Surgical clippng and endovascular coiling

Question 46

Where are some of the likely sites of anyersum formation?

Answer 46

Between anterior cerebral atery and the anterior communcating artery, between mca and the anterior choridla atery, theiddle cerebral atery and the biufrication of the basiliar artery

Question 47

Why do anyserums commonly form at biufrications?

Answer 47

There is a rapid change in blood flow direactiin, increases turbulence and may weaken the blood vessel walls

Question 48

What is some of the investigations that you would perform into a subarachoid heamorrhage!

Answer 48

Lumbar puncture is performed to aid diganosis, looking for the presence of red blood cells and xanthochromic, which is looking for a bilirubin like substance that appears within 12 hours of onset due to red blood cell breakdown

Question 49

How would you manage a subarachoid heamorrage?

Answer 49

Stabilise the paitent, prevent rebleeding, correct hyponatremia, and neurosurgical intreatvention, and treat the cerebral vasospasm and then neurosurgical intervention