traumatic brain and head injury

Question 1

definition of a traumatic brain injury

Answer 1

a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporary or permanent impairment of cognitive, physical and psychosocial functions

Question 2

who is high risk of a brain injury

Answer 2

-young men and elderly
-previous head injuries
-residents of inner cities
-alcohol and drug abuse
-low-income

Question 3

glasgow coma scale

Answer 3

Question 4

who should a CT scan be immediately requested for

Answer 4

-age >65yrs
-coagulopathy
-dangerous mechanism or injury

Question 5

classic presentation

Answer 5

-injury with loss of consciousness
-recovery lucid interval
-rapid progression of neurological symptoms
-deteriorating GCS
-possible hemiparesis
-unilateral fixed and dilated pupil
-apnoea and death

Question 6

assessment of brain injury

Answer 6

-ATLS (airway with C spine control, breathing, circulation)
-GCS and pupil response
-CT findings

Question 7

neurosurgical role in brain injury

Answer 7

to prevent secondary insults
-hypoxia
-hypotension
-mass lesions
-controlling ICP and CCP

Question 8

monro kellie principle

Answer 8

the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant. An increase in one should cause a reciprocal decrease in either one or both of the remaining two

Question 9

medical management of raised ICP

Answer 9

-sedation
-maximise venous drainage of brain
-CO2 control
-osmotic diuretics
-CSF release

Question 10

what is a diffuse axonal injury (DAI)

Answer 10

a type of traumatic brain injury that results from a blunt force to the brain
-occurs where density difference is greatest (grey/white interface)
-excitotoxicity and apoptosis
-inflammatory mediator response

Question 11

what is excitotoxicity

Answer 11

a phenomenon that describes the toxic actions of excitatory neurotransmitters, primarily glutamate
-excitatory amino acids
-activates NMDA receptors
-calcium mediated activation of proteases and lipases
-further cell death

Question 12

how do you confirm brainstem death

Answer 12

• No pupil response (II, III)
• No corneal reflex (V, VII)
• No motor response (CN distribution, V, VII)
• No vestibulo-ocular reflex (III, VI, VIII)
• No gag/cough reflex (IX, X)
• No respiration (apnoea test)

Question 13

what does an acute subdural haematoma look like on CT

Answer 13

-crescent shape
-white

Question 14

what does a chronic subdural haematoma look like

Answer 14

-crescent shape
-dark