Neurological Emergencies

Question 1

Pecarn rule

Answer 1

Clinical decision rule for determining when a child should get a CT after a traumatic brain injury

note the following is to rule OUT a CT, if the patient has these, then DONT get a CT

Children > 2 yrs:

• normal mental status
• normal behavior
• no loss of consciousness
• no severe mechanism of injury
• no non-frontal scalp hematoma
• no evidence of skull fracture

Children < 2yrs:

• normal mental status
• no loss of consciousness
• no severe mechanism of injury
• no vomiting
• no severe headache
• no signs of a basilar skull fracture

Question 2

Concussions

Answer 2

Immediate and transient alteration in brain unction including mental status and consciousness

Is a type of minor traumatic brain injury

CT (if your get one) shows up normal
- any blood or abnormalities = NOT concussion

players need to be symptom free before they return to play

Question 3

Complications of concussions

Answer 3

1) second impact syndrome
- massive edema in individuals that occur a second head injury prior to full recovery

2) CTE
- permanent changes in mood, behavior, cognition and dementia/Parkinson’s due to repetitive concussions

3) post concussive syndrome
- persistent headache, dizziness and inability to concentrate
- more common in females
- symptoms can persist for weeks-months
- CT is normal but bio markers shows concussion results.

Question 4

Skull fractures in children

Answer 4

Common and without injury to the brain, does not require specific treatments

Requires surgery If depressed skull fracture is greater than the width of the bone

can envelop leptomeningeal cysts and herniation of the brain, this is bad and needs to be surgery

Question 5

Basilar skull fractures

Answer 5

A fracture that involves one o the follow 5 bones

• temporal bone
• cribiform plate of ethmoid
• orbital plate of frontal bone
• petrous and squamous portion of temporal bone
• sphenoid and occipital bones

Signs are:

• hemotympanum
• raccoon eyes
• battle sign (mastoid bruising and bleeding)
• clear rinorrhea from nose or ear*

*Dangerous because it can cause bacterial infections in the sinuses and CNS system (due to dural tears)

Question 6

Cushing triad/reflex

Answer 6

Seen in tonsillar herniation affecting the brainstem (medulla)

1) irregular RR
2) extreme hypertension
3) bradycardia