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Neurology > Neurology: Head injury > Flashcards

Neurology: Head injury Flashcards

1
Q

What are the two types of insult in head injury?

A

Primary insult

Secondary insult

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2
Q

What is a primary insult in head injury?

A

Focal and/or diffuse brain trauma

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3
Q

What is a secondary insult in head injury?

A

Hypotension - low arterial BP
Hypoxia - low blood oxygen
Infection
Haematoma - bleeding/in around brain

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4
Q

How is conscious level assessed?

A

Glasgow Coma Scale (GCS)

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5
Q

What is a mild injury on the GCS?

A

13-15

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6
Q

What is a moderate injury on the GCS?

A

9-12

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7
Q

What is a severe injury on the GCS?

A

3-8

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8
Q

What are the three components of the GCS?

A

Eye opening
Verbal response
Motor response

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9
Q

What is the scale for rating eye opening in the GCS?

A

Spontaneous
To loud voice
To pain
None

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10
Q

What is the scale for rating verbal response in the GCS?

A 
Orientated
Confused, disorientated
Inappropriate words
Incomprehensible sounds
None
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11
Q

What is the scale for rating motor response in the GCS?

A 
Obeys
Localises
Withdraws (flexion)
Abnormal flexion posturing
Extension posturing
None
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12
Q

What are some of the complications of head injury?

A 
Permanent physical disability
Post traumatic epilepsy
Intracranial infection
Psychiatric illness
Chronic subdural haemorrhage
'Punch-drunk' dementia
Fatal
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13
Q

What is the mnemonic for remembering parts of the scalp and what are they?

A 
SCALP
S = skin
C = connective tissue
A = aponeurotic fascia
L = loose CT
P = pericranium
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14
Q

What is the bone composition of the skull?

A

Outer and inner compact bone separated by spongy bone

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15
Q

What are the brainstem and cerebellum called together?

A

Hindbrain

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16
Q

Where in the hindbrain positioned?

A

Posterior cranial fossa

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17
Q

What are the two elements of the skull?

A 
Skull vault (upper part)
Skull base (upon which the brain rests)
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18
Q

What does the skull vault include?

A

Includes frontal bone, squamous temporal bones and occipital bone, separated by sutures

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19
Q

What does the skull base include?

A

Anterior, middle and posterior cranial fossae

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20
Q

What is a linear skull fracture?

A

Commonly temporo-parietal from blow or fall onto side or top of the head and may continue onto the skull base

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21
Q

What is a depressed skull fracture?

A

Focal impact which may push fragments inwards to damage the meninges, blood vessels and the brain

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22
Q

What is there a risk of with a depressed skull fracture?

A

Meningitis and post-traumatic epilepsy

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23
Q

What is a comminuted (mosaic) skull fracture?

A

Fragmented skull

24
Q

What is a ring skull fracture?

A

Fracture line encircling the foramen magnum caused by a fall from height

25
Q

How does a fall from height cause a ring skull fracture?

A

Fall from height, usually lands on feet, sometimes head, skull base and cervical spine are forced together

26
Q

What is a ‘contre-coup’ skull fracture?

A

Fracturing of the orbital plates (anterior fossa) caused by a fall onto the back of the head

27
Q

What is an intracranial haemorrhage?

A

Accumulation of blood within the rigid skull causes an increase in ICP and results in compression of the brain

28
Q

What will happen if ICP continues to increase in an intracranial haemorrhage?

A

Death by compression of the brainstem due to herniation of the cerebellar tonsils into the foramen magnum

29
Q

What does intracranial haemorrhage cause along with symptoms?

A

Reduction in conscious level

30
Q

What is an extradural haemorrhage?

A

Bleeding occuring between the dura and the skull; accumulating blood strips the dura off the inner surface of the skull

31
Q

How do the vast majority of extradural haemorrhages occur?

A

Damage to an artery in association with a skull fracture

32
Q

Which artery classically causes extradural haemorrhages?

A

Middle meningeal artery

33
Q

How do neurological symptoms develop with an extradural haemorrhage?

A

Accumulation of blood (haematoma) can cause raised intracranial pressure

34
Q

What is a lucid interval?

A

Victim of injury seems to be okay without neurological symptoms but can deteriorate later

35
Q

What is a subdural haemorrhage?

A

Bleeding occurring beneath the dura (and above the arachnoid)

36
Q

What is a subdural haemorrhage usually caused by anatomically?

A

Bleeding from bridging veins which pass from the surface of the brain to drain into large venous channels within the dura

37
Q

How can a subdural haemorrhage be caused?

A

Any motion which causes rotational or ‘shearing’ forces can cause the veins to be stretched and torn

38
Q

Who is at an increased risk of subdural haemorrhage?

A

Those with atrophic (small) brains because the smaller brain has greater capacity for movement and the veins may be already stretched to some degree

39
Q

Can lucid intervals be seen with subdural haemorrhage?

A

Yes

40
Q

Which type of haemorrhage can often be mistaken for dementia?

A

Chronic subdural haemorrhage which causes chronic confusion

41
Q

What is a subarachnoid haemorrhage?

A

Bleeding beneath the arachnoid membrane and above the brain

42
Q

What is the most common cause of SAH?

A

Rupture of a cerebral artery (berry) aneurysm

43
Q

What is SAH frequency seen in associated with?

A

Cerebral contusions (bruising to the brain)

44
Q

What does TBSAH stand for?

A

Traumatic basal SAH

45
Q

What is TBSAH?

A

Forceful impact to the upper part of the side of the neck causing abrupt rotational movement of the head leading to rupture of the vertebro-basiliar circulation and a concentration of SAH on the base of the brain

46
Q

What are complications of intrinsic brain injury?

A

Cerebral oedema
Cerebral contusion and laceration
Coup contusion

47
Q

What can cerebral oedema lead to?

A

Massive brain swelling with raised ICP and ‘coning’

48
Q

What is cerebral contusion and laceration?

A

Direct mechanical damage to the brain substance

49
Q

What is a coup contusion?

A

Head is stuck with heavy blow and contusion is found directly under site of impact

50
Q

What is a counter-coup?

A

Caused by moving head striking fixed object or unyielding surface, contusions are found diametrically opposite the site of head impact

51
Q

What does tDAI stand for?

A

Traumatic diffuse axonal injury

52
Q

How can a diagnosis of tDAI be made?

A

Microscopy of the brain tissue

53
Q

What might raise suspicion of tDAI?

A

Concomitant damage to small blood vessels within the brain

54
Q

What are usual scenarios associated with tDAI?

A

Vehicle collisions

Falls from heights

55
Q

What is tDAI?

A

Serious rotational forces applied to brain tissue causing shearing of axons

56
Q

Which areas of the brain are particularly susceptible to displaying tDAI?

A 
Corpus callosum
Para-sagittal white mater
Posterior internal capsule
Dorsolateral aspects of the rostral brainstem
Cerebellar peduncles
57
Q

What are victims clinically when tDAI is fully developed?

A

Comatose

Neurology (9 decks)

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