Traumatic Brain and Head injuries Flashcards
define a head injury
non-degenerative, non-congenital insult to the brain from an external force potentially leading to temporary or permanent impairment
what score is used to check consciousness?
check GCS
Eye opening (out of 4)
Verbal communication/ response (out of 5)
Motor response (out of 6)
mild GCS
14 or 15/ brief LOC
moderate GCS
9-13
severe GCS
3-8
diagnosis
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
three types of intracranial haemorrhages
- SAH
- intracerebral
- intraventricular haemorrhage
what is a sub-arachnoid haemorrhage?
bleeding into the sub-arachnoid space
causes of SAH
Berry aneurysm (Circle of Willis) AVM
presentation of SAH
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
associations with SAH
cocaine
sickle cell anaemia
connective tissue disorders
NF
diagnosis of SAH
GCS
CT shows hyperattenuation in SAS
angiography to locate bleed
xanthochromic LP= yellow due to bilirubin/ fresh blood
management of SAH
surgical intervention for aneurysms e.g. coiling or clipping
nimodipine to avoid vasospasm
define an intracerebral haemorrhage
bleed into the brain parenchyma
define an intraventricular haemorrhage
rupture of SAH or intracerebral bleed into ventricle
define an extradural haemorrhage
bleed between the skull and dura that does not cross suture lines because the dura is adherent to the skull
presentation of extradural haemorrhage
injury with LOC
lucid interval (bad then recover, then deteriorate quickly)
rapid progression of neurological symptoms
diagnosis of extradural haemorrhage
CT= hyperdense bi-convex/ lens shape
associated temporal fractures
shifts/ herniations
common origin of extradural haemorrhage
middle meningeal artery at the pterion
define a subdural haemorrhage
bleed between the dura and arachnoid layer so not contained by suture lines
common cause of chronic subdural haemorrhage
cerebral bridging veins
more common in elderly due to brain atrophy
diagnosis of subdural haemorrhage
crescent shape on CT but can cross whole hemisphere
chronic is darker due to liquification
management of subdural haemorrhage
drainage/ craniotomy
describe diffuse axonal injury (DAI)
swelling of the brain due to shearing forces tearing axons causing excitotoxcity and apoptosis
occurs when density between white/grey matter is greatest
what can these haemorrhages cause for ICP?
cause it to raise
management of raised ICP
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
