Lecture 5 - Head Trauma

Question 1

new headache in patient older than 50 = probs ____;
thunderclap headache = _____;
jaw claudication =

Answer 1

cancer;
subarachnoid hemorrhage;
giant cell arteritis

Question 2

standard diagnostic workup:

mainly to exclude _____

Answer 2

non contrast head CT;
hemorrhage

need to do within 24 hours.

Question 3

what 3 things does the glasgow coma scale look at?

highest score would be…

Answer 3

eye opening (out of 4);
verbal response (out of 5);
best motor response (out of 6);

15

Question 4

concussion: secondary to primary contusion, brain injury typically causes cerebral ____ and release of metabolic _____

Answer 4

edema;

toxins

Question 5

4 critical elements of concussion testing:

Answer 5

history, physical, balance testing, cognitive testing

Question 6

concussion:
a glasgow coma score of less than ___, 2 or more episodes of ____, any sign of basilar fracture such as _____ should receive a CT.

Answer 6

15, vomiting, rhinorrhea;

also older than 65, seizures, amnesia before impact of 30 or more minutes

Question 7

postconcussion syndrome = symptoms occurs at least ____ after initial concussion;

second impact syndrome: due to diffuse cerebral _____ after trauma following initial concussion

Answer 7

4 weeks;

swelling

Question 8

repeated concussions can cause _____

Answer 8

chronic traumatic encephalopathy

Question 9

subarachnoid hemorrhage (SAH):
usually due to ______ or ____;
_____ on spinal type;
grossly, blood found where?

Answer 9

aneurysm rupture, AVM;
blood/xanthocrhomic (from bilirubin);
bottom of brain

CT best within 6 hours

Question 10

saccular aneurysm:
most common where?
why here in particular?
name 2 conditions that cause increased risk

Answer 10

junction of Acomm and ACA;
no media in blood vessels here;
polycystic kidney disease, ehler’s danlos

Question 11

classic risk factors of SAH

Answer 11

smoker, HTN, post menopausal woman

can occur after physical exertion

Question 12

4-10 days after SAH:
____ can occur due to blood breakdown or rebleed –> _____;
reduce risk of this with _____

Answer 12

vasospasm;
ischemic infarct;
nimodipine

Question 13

epidural hematoma:
rupture of _____;
often 2ndary to skull fracture involving the ____;
transient loss of consciousness –> ______

Answer 13

middle meningeal artery;
pterion;
lucid interval

Question 14

epidural hematoma:
_____ on CT;
does it cross suture lines or no?;

Answer 14

lense shaped/biconvex;

nope

Question 15

epidural hematoma:
elevated ICP causes ____ nerve palsy; can cause ____ herniation–> cushing reflex = _____ tension, ____ cardia, respiratory _____

Answer 15

CN 3;
transtentorial;
hypertension, bradycardia, resp depression

Question 16

epidural hematoma treatment:

____otomy or _____ evacuation

Answer 16

craniotomy, burr hole

reverse anticoagulation (wit h vitamin K/FFP/PT concentrate)

Question 17

subdural hematoma:
rupture of ____;
acutely, due to _____; ___dense on CT

Answer 17

bridging veins;

trauma, hyperdense

Question 18

chronic subdural hematoma:
associated with _____, elderly patients, or ______;
_____dense on CT;
also seen in ____ babies

Answer 18

cerebral atrophy, alcoholics;
hypodense;
shaken

Question 19

subdural hematoma:
____ shaped on CT’
crosses suture lines or no?

Answer 19

crescent;

crosses lines

Question 20

of SAH, epidural, and subdural hematomas, which should get an LP?

Answer 20

just SAH