surgery - NEURO traumatic injuries Flashcards
red flag signs in head injury
Impaired consciousness level
Dilated pupils which do not respond to light (“fixed and dilated”)
Signs of basal skull fracture
Focal neurological deficit or visual disturbances
Seizures or amnesia
Significant headache or nausea and vomiting
what imaging for head injury?
CT
who gets CT in 1hr?
GCS <13 on first assessment or GCS <15 at 2 hours after injury
Signs of basal skull fracture, or open or depressed skull fracture
Seizure or >1 episode of vomiting
Focal neurological deficit (e.g. focal weakness or paraesthesia)
who gets CT in 8hr?
CT scanning of the head should be performed within 8 hours if they are on an anti-coagulant, or they have suffered loss of consciousness / memory loss AND any of the following signs are present:
Aged over 65 years
Previous bleeding disorder
‘Dangerous’ mechanism of injury, e.g. cyclist vs. vehicle or fall from height >1m
More than 30 minutes of retrograde amnesia of events before the head injury
when do you refer to neurosurgery?
Significant abnormality on imaging
GCS 8 or less after resuscitation, or drop in GCS after admission (especially in motor component)
Unexplained confusion >4 hours
Focal neurological signs or seizures without full recovery
Suspected penetrating injury or evidence of cerebrospinal fluid leak
what is diffuse axonal injury?
causes?
The resistant inertia that occurs to the brain at the time of injury, preceding and following its sudden acceleration against the solid skull, causes shearing of the axonal tracts of the white matter.
RTA
child abuse eg shaken baby
abusive head trauma
grading of diffuse axonal injury?
pathophysiology of diffuse axonal injury
rapid acceleration or deceleration results in traumatic shearing forces.
Axonal disconnection and mechanical disruption - severe brain injury
delayed secondary axonal disconnection
features of diffuse axonal injury?
loss of consciousness
prolonged post-traumatic coma
only suspected when patients do not make a neurological recovery
imaging for diffuse axonal injury?
non contrast CT may be normal
MRI best
mx of diffuse axons injury
resuscitated and stabilised
preventing secondary effects such as cerebral oedema or haemorrhage
monitoring
brain injury rehab
what is traumatic spinal cord injury?
traumatic injury leading to damage of spinal cord
temporary or permanent change to neurological function inc paralysis
causes of traumatic spinal cord injury?
falls
road traffic collisions
sport injuries
classification of traumatic spinal cord injury?
complete or incomplete
complete traumatic spinal cord injury?
A complete injury is damage occurring across the whole spinal cord width, leading to complete loss of sensation and paralysis below the level of injury
incomplete traumatic spinal cord injury?
An incomplete injury is the injury is spread across part of the spinal cord thereby only partially affecting sensation or movement below the level of injury
pathophsyiology of traumatic spinal cord injury?
initial acute impact
compression on the spinal cord from increased pressures
blocked venous return and oedema around the spinal cord
ischaemia due to compromised arterial supply
features of traumatic spinal cord injury?
Pain may not be presen
loss of motor function, loss of sensory function, bowel incontinence, or urinary incontinence
mx of traumatic spinal cord injury?
surgery if progressive neurological deficit or a dislocation-type injury
Cervical spine surgery aims to realign the spine, decompress the neural tissue, and stabilise the spine with internal fixation (screws, plates, cages)
Thoracolumbar spine surgery typically involves spinal decompression, discectomy, spinal fixation, or spinal cord simulation
physio
mx of extradural haematoma?
craniotomy or burr holes
post op CT scan
mx of subdural haematoma?
anti-epileptics for 1 wk
acute = evacuate haematoma - decompressive craniotomy
chronic = burr hole craniotomy
