Traumatic Brain and Head injuries

Question 1

define a head injury

Answer 1

non-degenerative, non-congenital insult to the brain from an external force potentially leading to temporary or permanent impairment

Question 2

what score is used to check consciousness?

Answer 2

check GCS
Eye opening (out of 4)
Verbal communication/ response (out of 5)
Motor response (out of 6)

Question 3

mild GCS

Answer 3

14 or 15/ brief LOC

Question 4

moderate GCS

Answer 4

9-13

Question 5

severe GCS

Answer 5

3-8

Question 6

diagnosis

Answer 6

CT to check for haematomas
herniations:
- uncal= unreactive pupil due to temporal lobe pressing on CNIII, Cushing’s triad
- Falcine= leg symptoms and midline shift

Question 7

three types of intracranial haemorrhages

Answer 7

1. SAH
2. intracerebral
3. intraventricular haemorrhage

Question 8

what is a sub-arachnoid haemorrhage?

Answer 8

bleeding into the sub-arachnoid space

Question 9

causes of SAH

Answer 9

Berry aneurysm (Circle of Willis)
AVM

Question 10

presentation of SAH

Answer 10

sudden onset severe thunderclap headache
vomiting, collapse, neck pain, photophobia
focal neurological deficit e.g. CNIII palsy, dysphasia, hemiparesis, seizure, etc.
can have history of strenuous activity

Question 11

associations with SAH

Answer 11

cocaine
sickle cell anaemia
connective tissue disorders
NF

Question 12

diagnosis of SAH

Answer 12

GCS
CT shows hyperattenuation in SAS
angiography to locate bleed
xanthochromic LP= yellow due to bilirubin/ fresh blood

Question 13

management of SAH

Answer 13

surgical intervention for aneurysms e.g. coiling or clipping

nimodipine to avoid vasospasm

Question 14

define an intracerebral haemorrhage

Answer 14

bleed into the brain parenchyma

Question 15

define an intraventricular haemorrhage

Answer 15

rupture of SAH or intracerebral bleed into ventricle

Question 16

define an extradural haemorrhage

Answer 16

bleed between the skull and dura that does not cross suture lines because the dura is adherent to the skull

Question 17

presentation of extradural haemorrhage

Answer 17

injury with LOC
lucid interval (bad then recover, then deteriorate quickly)
rapid progression of neurological symptoms

Question 18

diagnosis of extradural haemorrhage

Answer 18

CT= hyperdense bi-convex/ lens shape
associated temporal fractures
shifts/ herniations

Question 19

common origin of extradural haemorrhage

Answer 19

middle meningeal artery at the pterion

Question 20

define a subdural haemorrhage

Answer 20

bleed between the dura and arachnoid layer so not contained by suture lines

Question 21

common cause of chronic subdural haemorrhage

Answer 21

cerebral bridging veins

more common in elderly due to brain atrophy

Question 22

diagnosis of subdural haemorrhage

Answer 22

crescent shape on CT but can cross whole hemisphere

chronic is darker due to liquification

Question 23

management of subdural haemorrhage

Answer 23

drainage/ craniotomy

Question 24

describe diffuse axonal injury (DAI)

Answer 24

swelling of the brain due to shearing forces tearing axons causing excitotoxcity and apoptosis

occurs when density between white/grey matter is greatest

Question 25

what can these haemorrhages cause for ICP?

Answer 25

cause it to raise

Question 26

management of raised ICP

Answer 26

sedation e.g. propofol, BZDs, barbiturates
maximise venous drainage e.g. head of bed tilt, collar, ET tube ties
CO2 control, osmotic diuretics (mannitol, hypertonic saline)
CSF release
decompressive craniotomy