Trauma, Head

Question 1

EDH presentation

Answer 1

• caused by head trauma
• a/w skull fracture
• initially regain normal level of consciousness
• lucid intervals
• ongoing, severe headache
• rapid deterioration

Question 2

Source of bleeding in EDH

Answer 2

Middle meningeal artery

Question 3

SDH presentation

Answer 3

• suspect in elderly due to decrease in brain volume (veins more prone to tearing)
• can be due to head trauma
• minor, chronic headache
• sinister progression

Question 4

Source of bleeding in SDH

Answer 4

Bridging veins

Question 5

SAH presentation

Answer 5

• due to head trauma or ruptured berry aneurysm or ruptured AVM (circle of willis)
• traumatic SAH = hyperdense areas seen over at cortical surfaces
• non-traumatic SAH = hyperdense areas in basal cisterns

Question 6

Management of head trauma

Answer 6

ATLS:
ABCDE, secondary survey
+ ETT for GCS < 9
+ seizure prophylaxis

Question 7

Complication of raised ICP

Answer 7

Uncal herniation

Question 8

Signs of raised ICP or brain herniation

Answer 8

1. Dilated and non-reactive pupils (‘blown’ pupil)
   - medial temporal lobe mass causes uncus of temporal lobe to be displaced inferiorly through medial edge of tentorium, compressing parasympathetic fibres of 3rd cranial nerve
2. Asymmetric pupils
3. Extensor posturing
4. Cushing reflex
5. Progressive decline in neurological condition (drop in GCS >2 points)

Question 9

Triad of Cushing reflex

Answer 9

Hypertension
Bradycardia
Irregular respirations

Question 10

Medical management of elevated ICP

Answer 10

1. Elevate head to 30 degrees (reverse Trendelenburg) to increase gravitational CSF drainage
2. Hyperosmolar therapy
   - IV mannitol
3. Optimise cerebral perfusion (SBP > 100-110, CPP 60-70mmHg)
4. +/- Temporary hyperventilation
5. Analgesia and sedation
6. Maintain normothermia
7. Seizure prophylaxis