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(LUSUMA) Clinical Neuroscience > S10) Head Trauma and Acute Intracranial Events > Flashcards

S10) Head Trauma and Acute Intracranial Events Flashcards

1
Q

How can one classify different head injuries?

A
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2
Q

How can one classify different traumatic head injuries?

A
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3
Q

What is a cerebral contusion?

A

A cerebral contusion is the bruising of the brain whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks

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4
Q

In six steps, describe the pathophysiology of cerebral contusion

A

⇒ Trauma

⇒ Microhaemorrhages

⇒ Cerebral contusion

⇒ Cerebral oedema/Intracerebral bleed

⇒ Raised ICP

⇒ Coma

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5
Q

What is a concussion?

A

A concussion is a head injury with a temporary loss of brain function

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6
Q

In four steps, describe the pathophysiology of a concussion

A

⇒ Trauma

⇒ Stretching and injury to axons

⇒ Impaired neurotransmission, loss of ion regulation, ↓cerebral blood flow

⇒ Temporary brain dysfunction

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7
Q

Describe some features of post concussion syndrome

A
  • Sleep disturbance
  • Emotional/mood changes
  • Thinking/remembering difficulties
  • Physical symptoms (headaches, nausea, dizziness)
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8
Q

What is diffuse axonal injury?

A

Diffuse axonal injury is the shearing of the interface between grey and white matter following traumatic acceleration/deceleration or rotational injuries to the brain damaging the intra- cerebral axons and dendritic connections

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9
Q

In six steps, describe the pathophysiology of a diffuse axonal injury

A

⇒ Trauma

⇒ Shearing of grey and white matter interface

⇒ Axonal death

⇒ Cerebral oedema

⇒ Raised ICP

⇒ Coma

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10
Q

What is a basilar skull fracture?

A

A basilar skull fracture is a bony fracture within the base of skull (temporal, occipital, sphenoid or ethmoid bone)

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11
Q

In three steps, describe the pathophysiology of a basilar skull fracture

A

⇒ Trauma

⇒ Tears in the meninges

⇒ CSF leakage

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12
Q

Identify six signs of a basilar skull fracture

A
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13
Q

Outline the management for a basilar skull fracture

A
  • Traumatic brain injury management (incl ICP control)
  • Seek and treat complications
  • Elevation of depressed skull fractures
  • Persistent CSF leak management → surgery
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14
Q

Indicate the three factors which determine whether a traumatic head injury is mild, moderate or severe

A
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15
Q

How does an EDH present on a CT head scan?

A
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16
Q

What are the urgent CT head criteria relating to consciousness?

A
  • GCS < 13 at any point
  • GCS < 14 2/more hours after injury
17
Q

What are the urgent CT head criteria relating to neurological abnormalities?

A
  • Focal neurological deficit
  • Seizure
  • Loss of consciousness with any of: age >65, coagulopathy, dangerous mechanism of injury, antegrade amnesia >30 minutes
18
Q

Apart from consciousness and neurological abnormalities, what are the other urgent CT head criteria?

A
  • Suspected open/depressed skull fracture
  • Signs of basal skull fracture
  • 2+ discrete episodes of vomiting
19
Q

What is an extradural haemorrhage?

A
  • An extradural haemorrhage is the collection of blood between inner surface of the skull and the periosteal dura mater
  • It is nearly always secondary to trauma and/or skull fracture and most commonly occurs due to a severed middle meningeal artery
20
Q

In three steps, describe how levels of consciousness vary in extradural haemorrhages

A

⇒ Patient will present with LOC due to impact of initial injury

⇒ Followed by transient recovery with ongoing headache known as a ‘lucid interval’ (40% of patients)

⇒ Haematoma enlarges and ↑ ICP causing compression of the brain and rapidly deteriorating level of consciousness

21
Q

The prognosis of EDH is generally good with early intervention.

Describe the management for small and large EDH respectively

A
  • Small EDH can be observed and managed conservatively with neurological follow up
  • Large EDH require referral to neurosurgery for craniotomy and clot evacuation
22
Q

Identify 6 complications of extradural haemorrhages

A
  • Permanent brain damage
  • Coma
  • Seizures
  • Weakness
  • Pseudoaneurysm
  • Arteriovenous fistula
23
Q

What is a subdural haemorrhage?

A
  • A subdural haemorrhage is the collection of blood between meningeal dura mater and the arachnoid mater
  • Bleeding occurs due to shearing forces on cortical bridging veins
24
Q

How might the presentations of SDHs vary chronologically?

A
  • Acute (<3 days)
  • Subacute (3-21 days)
  • Chronic (>3 weeks)
25
Q

How does an acute SDH present on a CT head scan?

A
26
Q

How does a chronic SDH present on a CT head scan?

A
27
Q

The prognosis of SDH is a lot poorer than EDH.

Describe the management for chronic and acute SDH respectively

A
  • Small chronic SDH can be evaluated with serial imaging
  • Acute SDH need immediate neurosurgical intervention to relieve raised ICP
  • Symptomatic subacute/chronic SDH are often treated via one or more burr hole
28
Q

Compare and contrast the different presentation of EDHs and SDHs on CT head scans

A
  • EDH – lentiform / biconcave
  • SDH – crescent / sickle
29
Q

What is a subarachnoid haemorrhage?

A
  • A subarachnoid haemorrhage is a collection of blood between arachnoid mater and the pia mater
  • Vast majority of SAH occurs spontaneously, secondary to ruptured berry aneurysm (may also be traumatic)
30
Q

Identify six clinical symptoms of subarachnoid haemorrhages

A
  • Sudden onset ‘thunderclap’ headache
  • Meningism
  • Nausea & vomiting
  • Fever
  • Focal neurological deficits
  • LOC
31
Q

Identify some sites of aneurysm formation for SAHs

A
32
Q

Do berry aneurysms present with symptoms?

A

Berry aneurysms are largely asymptomatic but symptoms may arise if compressing on nearby structures or during early stages of rupture

33
Q

What are the risk factors for berry aneurysms?

A
  • Family history
  • Hypertension
  • Heavy alcohol consumption
  • Abnormal connective tissue (Ehlers-Danlos, Marfan’s Disease)
34
Q

How does a SAH present on a CT head scan?

A
35
Q

Explain how a lumbar puncture aids the diagnosis of an SAH

A

Lumbar puncture performed to aid diagnosis:

  • Presence of RBCs (same number in 3 bottles)
  • Xanthochromia (within 12 hours after symptom onset)
36
Q

Describe the five steps in the clinical management of subarachnoid haemorrhages

A

⇒ Stabilise the patient

⇒ Prevent rebleeding

⇒ Treat cerebral vasospasm

⇒ Correct hyponatraemia

⇒ Neurosurgical intervention (if large bleed)

37
Q

What does the prognosis of an SAH depend on?

A

Prognosis depends on GCS, degree of neurological deficit at the time of presentation and comorbidities

38
Q

Identify six complications of SAHs

A
  • Hydrocephalus
  • Focal neurological deficits
  • Coma
  • Seizures
  • Cognitive decline
  • Frequent headaches

(LUSUMA) Clinical Neuroscience (21 decks)

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