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Nervous System And Neuropsychiatry > Session 10 L2: Head Trauma and Acute Intracranial Events > Flashcards

Session 10 L2: Head Trauma and Acute Intracranial Events Flashcards

1
Q

What is Cerebral Contusion?

A

Bruising” of brain whereby blood mixes with cortical tissue due to micro-haemorrhages and small blood vessel leaks.

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2
Q

What is the pathophysiology of a Cerebral contusion?

A

Trauma to micro-haemorrhages to cerebral contusion to cerebral oedema/intracerebral bleed to raised intracranial pressure to coma

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3
Q

What is the definition of a concussion?

A

Head injury with temporary loss of brain function

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4
Q

What is the pathophysiology of a concussion?

A
  • Trauma
  • Stretching and injury of axons
  • Impaired neurotransmission, and loss of ion regulation and a reduction in cerebral blood flow.
  • This can all lead to temporary brain dysfunction
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5
Q

What is are the different factors involved in Post concussion syndrome?

A
  • Thinking/Remembering
  • Physical
  • Emotional/Mood
  • Sleep disturbance
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6
Q

What is involved in the thinking/remembering aspect of post concussion syndrome?

A
  • Difficult thinking clearly
  • Feeling slowed down
  • Difficult concentrating
  • Difficulty remembering new information
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7
Q

What is involved in the physical aspect of post concussion syndrome?

A
  • Headache
  • Nausea or vomiting (early on)
  • Balance problems
  • Dizziness
  • Fuzzy or blurry vision
  • Feeling tired, having no energy
  • Sensitivity to noise or light
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8
Q

What is involved in the emotion/mood aspect of post concussion syndrome?

A
  • Irritability
  • Sadness
  • More emotional
  • Nervousness or anxiety
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9
Q

What is involved in the sleep disturbance aspect of post concussion syndrome?

A
  • Sleeping more than usual
  • Sleeping less than usual
  • Trouble falling asleep
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10
Q

What is the definition of diffuse axonal injury?

A

Shearing of 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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11
Q

What is the pathophysiology a diffuse axonal injury?

A
  • Trauma
  • Shearing of grey and white matter interface
  • Axonal death leading to cerebral oedema
  • Raised intracranial pressure
  • This can lead to a coma
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12
Q

What is the definition of a basilar skull fracture?

A

Bony fracture within the base of skull (temporal, occipital, sphenoid, or ethmoid bone)

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13
Q

What is the pathophysiology of a basilar skull fracture?

A

Trauma leads to tears in the meninges which can cause CSF to leak

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14
Q

What are the clinical signs of basilar skull fractures?

A
  • Raccoon eyes
  • CSF rhinorrhoea
  • CSF otorrhea
  • Battle signs
  • Haemotympanum
  • Bump
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15
Q

What is the management of Basilar skull fractures?

A
  • Traumatic brain injury management (including ICP control)
  • Seek and treat complications
  • Elevation of depressed skull fractures
  • Persistent CSF leak management requires surgery
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16
Q

What is an extradural haemorrhage?

A

Collection of blood between INNER SURFACE of skull and PERIOSTEAL DURA MATER

17
Q

What is the common mechanism of an extradural haemorrhage?

A
  • Nearly always secondary to trauma and/or skull fracture typically in younger patients
  • Most cases (90%) involve a severed artery – most commonly middle meningeal artery
  • Supratentorial in most cases
  • If its venous involvement, then torn venous sinus
18
Q

What is the presentation of an extradural haemorrhage?

A
  • Loss of consciousness due to impact of initial injury
  • Followed by transient recovery with ongoing headache known as a lucid interval in 40% of patients
  • As haematoma enlarges, ICP will increase causing compression of the brain and rapidly deteriorating level of consciousness
  • Cranial nerve palsies may be found on examination as the brain structures herniate
19
Q

What is the management of Extradural haemorrhages?

A
  • Prognosis generally good with early intervention
  • Small EDH can be observed and managed conservatively with neurological follow up
  • Large EDH require referral to neurosurgery for craniotomy and clot evacuation
20
Q

What are the complications of Extradural haemorrhages?

A
  • Permanent brain damage
  • Coma
  • Seizures
  • Weakness
  • Psuedo-aneurysm
  • Arteriovenous fistula
21
Q

What is a subdural haemorrhage?

A

-Collection of blood between MENINGEAL DURA MATER and ARACHNOID MATER

22
Q

What is the common mechanism of action of Subdural haemorrhage?

A
  • Can occur in all age groups and could be ACUTE, SUBACUTE, CHRONIC (more common in elderly)
  • Bleeding occurs due to shearing forces on cortical bridging veins
  • Most often associated with trauma but can be spontaneous.
  • Cerebral atrophy increases the risk of rupture
23
Q

What is the presentation of Subdural Haemorrhages?

A
  • ACUTE Sub-Dural Haemorrhage usually present in the setting of head trauma
  • Neurological abnormalities in up to 80%
  • May present with insidious onset of confusion and general cognitive decline similar to dementia
  • Acute bleeds generally appear hyper dense i.e. brighter than brain tissue on CT.
  • Haematoma will become progressively hypodense over time i.e. darker than brain tissue
24
Q

What is the management of Sub-dural haemorrhages?

A
  • Small CHRONIC haematomas can be evaluated with serial imaging
  • ACUTE collections need immediate neurosurgical intervention to relieve raised ICP
  • Symptomatic SUBACUTE/CHRONIC SDH are often treated via one or more burr holes
25
Q

What is the prognosis of a subdural haemorrhage?

A
  • Mortality in acute subdural haematomas requiring surgery intervention may exceed 50%. Full recovery may only be achieved in 20% of patients. Worse outcomes in patients who are anticoagulated
  • Worse prognosis compared t Extradural haemorrhage
26
Q

What is a subarachnoid haemorrhage?

A

Collection of blood between ARACHNOID MATER and PIA MATER

27
Q

What are the features of a subarachnoid haemorrhage?

A
  • Usually occur in middle aged patients <60

- Vast majority of SAH occur spontaneously secondary to ruptured berry aneurysm but may also be traumatic

28
Q

How does a subarachnoid haemorrhage present?

A
  • Sudden onset ‘thunderclap’ headache
  • Meningism – symptoms caused by irritation of meninges
  • Nausea and Vomiting
  • Fever
  • Focal neurological deficits
  • LOC
29
Q

What is a berry aneurysm?

A
  • Largely asymptomatic but symptoms may arise if compressing on nearby structures or during early stages of rupture
  • Around 3% of population may have one or more aneurysm
30
Q

How can a berry aneurysm be controlled?

A

-Surgical clipping and endovascular coiling can be performed if risk of rupture is high

31
Q

What are the risk factors of a berry aneurysm?

A
  • Family history
  • Hypertension
  • Heavy alcohol consumption
  • Abnormal connective tissue (Autosomal Dominant Polycystic Kidney Disease, Ehlers-Danlos, Neurofibromatosis, Marfan’s Disease)
32
Q

How is a sub arachnoid haemorrhage investigated?

A

Lumbar puncture
• Presence of RBCs
• Xanthochromia

33
Q

What is the prognosis of a subarachnoid haemorrhage?

A

Prognosis depends on GCS, degree of neurological deficit at the time of presentation and comorbidities
-Mortality between 30% and 90%

34
Q

What are the complication of a sub arachnoid haemorrhage?

A
  • Hydrocephalus
  • Focal neurological deficits, coma
  • Seizures
  • Cognitive decline
  • Frequent headaches
  • Hypopituitarism
35
Q

How are patients with a sub-arachnoid haemorrhage managed?

A
  • Stabilise the patient
  • Prevent re-bleeding
  • Treat cerebral vasospasm
  • Correct Hyponatraemia
  • Neurosurgical intervention if large bleed

Nervous System And Neuropsychiatry (20 decks)

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