Trauma Flashcards
what types of axonal and contusional injuries are there
rotation (shear) - traumatic axonal and micro-vascular injury
translation (linear) - coup and contro coup contusions
impact and crush
what symptoms/effects show with fronto-temporal contusions after primary injury acute
cognitive, affective, behavioural problems, poor judgement and planning, anxiety, impulsivity
what happens in primary injurry after mod/sever TBI
can have microhaemorrhages, microbleeds
spastic-ataxic quadriparesis, prolonged PTA, executive problems and cognitive slowing
within how many hours do subdurals need decompression
4 hours
what is delirium
“(sometimes called ‘acute confusional state’) is characterised by
disturbed consciousness, cognitive function or perception, which has an acute onset
and fluctuating course… can be hypoactive, hyperactive or mixed…and can be
restless, agitated and aggressive (or) withdrawn, quiet and sleepy…. caused by the
direct physiological consequences of a general medical condition.”
what are neuro consequences of severe TBI
Hydrocephalus and intracranial hypotension
• Asymmetric spastic-ataxic quadriparesis, +/- (Holmes) tremor
• Hemiparesis, ipsi-lesional (Kernohan) or contra-lesional or both
• Imbalance commonest residual physical problem
• Thalamic pain
• Bulbar problems and incontinence
• Autonomic storms, & hypothalamic and hypothalamic-pituitary axis dysfunction
• ‘Syndrome of the trephined’
• Cranial neuropathies
Particularly with skull-base & facial fractures
May cause bilateral & profound deafness
IX-XII uncommon
Traumatic optic neuropathies vs. Terson’s syndrome
• Incidental carotid/vertebral dissection, hyperextension myelopathies, traumatic
plexopathies, compression mononeuropathies
• Heterotopic ossification
• Post-traumatic epilepsy
what is diagnosis based on behaviour influenced by
- Medical instability
- Nutritional state
- Medication eg. AEDs
- Altered sleep/wake cycle
- Severe physical impairment
- Positioning masking ability
- Repetitive movements
- Sensory impairments, particularly deafness & blindness
- Communication & behavioural problems
- Fluctuating attention and responsiveness
- Environmental problems
- New/inexperienced assessor
- Possibility of covert awareness
what imaging can you use to test brain activity
fMRI
Why use Skull radiographs (SXR)
can see calvarial fractures, penetrating injuries, radiopaque foreign bodies
what is CT good for in TBI
sensitive for mass effect, ventricular size, bone injuries and acute haemorrhage
available, quick
why is CT not good in tbi
ionising radiation
might not detect small and non-haemorrhagic lesions, DAI, ICP, cerebral oedema
why is MRI good in TBI
sensitive for subacute and chronic brain injuries
DWI improves detection of acute infarction.
FLAIR imaging sensitive for subarachnoid haemorrhage and lesions bordered by CSF
why is MRI not good in TBI
limited in acute trauma setting
long imaging times
insensitive to subarachnoid haemorrhage
what is angiography good for
dissection depiction.
cta and mra less invasice
mra can reveal carotid or vertebral dissection
what are divisions of primary neuronal injury
cortical contusions
diffuse axonal injury
primary brain stem injury
what are divisions of primary haemorrhage
subararachnoid
subdural
extradural
intracerebral
what is cortical contusion
consequence of direct trauma usually against skull
skull impacts on brain forms ‘brain bruise’ can be haemorrhagic
what can happen diffuse axonal injury
non linear accelerative force
with ct can’t distinguish DAI early on
mri can pick deep in
what can vascular injuries lead to
dissections, lacerations, occlusions, pseudoaneurysms, arteriovenous fistulas
what are vascular injuries caused by often
basal skull injuries
when is surgery needed for in fractures
depressed skull more than full thickness of the skull
open fractures that give rise to pneumocephalus
relieves or prevent CSF leakage, infection, haemorrhage, or vascular compromise
what can be used to detect sites of CSF leaks in fractures
CT, contrast CT or radionuclide cisternography used for detecting sites of CSF leaks
what do foreign bodies cause damage by several mechanisms depneding on size and velocity of:
direct laceration
shock-wave transmission
cavitation
what is common in secondary injury
territorial arterial infarction global anoxia and ischemia pressure necrosis brain herniation syndromes delayed haemorrhages secondary brain stem injuries
what is chronic sequelae of head injury characterised by
parenchymal atrophy residual hemoglobin degradation products residual hemoglobin degradation products Wallerian-type axonal degeneration demyelination cavitation microglial scarring
what parts of body to consider with spinal cord imaging
anterior 2/3 vertebral body, disc and anterior longitudinal ligament
posterior 1/3 vertebral body, disc and pll
pedicles transverse processes, laminae, articular facets and spinous processes
if 2 columns disrupted = unstable injury
Nice guidelines NG41 - assessment of clinical severity by the Canadian C-spine rule
when to do spine multimodal imaging if child or adult
child - MRI if strong suspicion otherwise x-ray
adults - CT if by Canadian spine rule or T or L injury
otherwise x-ray or MRI
what are mechanisms of cervical injury
hyperflexion
hyperextension
axial compression
what are upper cervical spine fractures
complex flexion/extension atlanto-occipital dislocation odontoid peg fractures extension- Hangman's fracture vertical compression - Jefferson's fracture
What are lower cervical spine fractures
flexion –> flexion teardrop fracture, wedge compression fracture, Clay shoveler’s fracture, bilateral facet joint dislocation
flexion-rotation - unilateral facet joint dislocation
vertical compression - Burst fracture
what types of soft tissue spinal injuries are there
anterior subluxation ligamentous injuries cord contusion brachial plexus injuries vertebral arteries
what are types of thoracolumbra spine fractures
wedge compression fractures burst fractures chance fractures spondylolisthesis spondylolysis
