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NEUROLOGY > Traumatic Brain and Head Injury > Flashcards

Traumatic Brain and Head Injury Flashcards

1
Q

What groups are at a higher risk of a traumatic brain injury?

A
  • Young men (due to risk taking)
  • Elderly (risk of falling)
  • Previous head injuries
  • Residents of inner cities
  • Alcohol and drug abuse
  • Low-income
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2
Q

What are the main mechanisms of brain/head injury?

A
  • Assault
  • Falls
  • *BOTH CAN BE DUE TO ALCOHOL**
  • Road traffic collisions
  • Sports
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3
Q

What laws have the government put in place in order to prevent traumatic brain injury?

A
  • Seatbelt laws
  • Drink driving testing
  • Helmets on motorbikes/ bicycles
  • Air bags
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4
Q

What medication should we as doctors be aware of prescribing if a patient is at risk of falling and causing a brain injury?

A

Anticoagulants

need to weigh up risk (fall and brain injury) and benefits (AF - stroke prevention

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5
Q

Why do elderly patients tear a lot of their scalp during a head injury?

A

it is thin and therefore peels away easily during injury

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6
Q

At what intervals after a brain/head injury are most patients likely to die or deteriorate?

A

1st Peak: Most dead within 1st hour “Golden Hour”

2nd Peak: 7 hours later patients deteriorate due to secondary effects of injury

3rd Peak: Medical complications cause deterioration

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7
Q

How are patients with traumatic brain or head injury first managed?

A

Airway (and C spine control)
Breathing
Circulation

intubate, ventilate

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8
Q

How should a patient be further assessed after the Primary ABCDE survey?

A
  • Glasgow Coma Scale
  • Pupil Reactivity
  • Secondary survey ABCDE
  • History
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9
Q

What are the 3 main components of the Glasgow Coma Scale?

A

Eye opening
Motor
Verbal

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10
Q

What patients require a CT within ONE HOUR?

A
  • GCS<13 on initial assessment
  • GCS <15 2 hours after injury
  • Suspected skull fracture/ basal skull fracture
  • Post traumatic seizure
  • Focal Neurological Deficit
  • > 1 episode vomiting
  • Suspicion of NAI
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11
Q

What patients should get a CT scan if there has been any evidence of unconsciousness of amnesia since the injury?

A
  • Age >65
  • Patients with a Coagulopathy
  • Dangerous mechanism of injury
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12
Q

What clinical signs can indicate a base of skull fracture?

A

“Raccoon Eyes” - Periorbital haematoma
Battle’s sign - bruising over mastoid
Blood or CSF coming out of ear

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13
Q

Which of the sections of the glasgow coma scale is most important in telling us the status of a patient?

A

Motor section

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14
Q

Describe how an extradural haematoma appears on a scan

A 
Doesn't cross any suture lines
Biconvex shape (Lemon)
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15
Q

How do patients present when they have developed an extradural haematoma?

A
  • Initial loss of consciousness after injury
  • Recover for a period of time “lucid interval”
  • *often present to ED in this state^**
  • THEN rapid progression and deteriorating GCS
  • hemiparesis
  • Unilateral fixed and dilated pupil
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16
Q

How does a subdural haematoma appear on a scan?

A
  • Banana shape on scan

- hyperdense as blood has usually clotted before visualisation

17
Q

What patients are most likely to get subdural haematomas?

A
  • elderly (as brain volume has shrunk)

- bridging veins more susceptible to damage when they fall etc

18
Q

What are the two different types of intracerebral haemorrhage?

A

focal

contusion (bruising across majority of brain)

19
Q

What two factors of injury increase the risk of developing a haematoma?

A

Skull fracture and loss of consciousness

20
Q

What occurs during diffuse axonal injury?

A
  • axons can be sheared, stretched, twisted or compressed
  • More ions and water allowed into neuronal cell bodies
    => brain swells
21
Q

Where does most diffuse axonal injury occur and why?

A
  • Grey/white matter junction
  • due to different matter densities rubbing against each other, injury creates enough force in this movement to break axons
22
Q

What secondary injury insults do doctors wish to prevent?

A
  • Hypoxia
  • Hypotension
  • Mass lesions
  • Controlling ICP and Cerebral perfusion pressure
23
Q

What should be considered before transferring patients to surgery?

A

Are they elderly?
Are they haemodynamically stable?
Are they on anticoag/antiplatelets?
Do they have a raised ICP?

24
Q

How does the ICP normally rise in the brain due to injury?

A

Brain compensates for a period of time then rise is exponential

25
Q

How can the brain tissue herniate to try and combat the raised ICP involved in injury?

A
  1. Subfalcine
  2. Subtentorial
  3. Central (coning) - brainstem moves into foramen magnum
26
Q

A large area of skull is cut when trying to remove a haematoma. TRUE/FALSE?

A

TRUE

- if blood is clotted, a lot of skull is removed to see pathology under

27
Q

If a patient is not suitable for surgery, what can we do to keep them stable?

A

Intubate, ventilate, sedate

28
Q

How is ICP directly measured?

A

Small incision into skull, wire inserted to measure pressure from inside

29
Q

What is an ideal pCO2 and why is this?

A

Ideal = 4.5

Otherwise a rise in CO2 increases cerebral blood flow and therefore increases ICP

30
Q

What angle should patients with head/brain injuries be kept at and why?

A

30 degrees

- promotes maximum cerebral blood flow and lowest ICP

31
Q

What is a decompressive craniotomy and when is it performed?

A
  • Removal of frontal bone to increase space in the cranial cavity => decrease ICP
  • Used as a last resort - long term complications
  • Replacement plate inserted later but high risk of infection with this
32
Q

How can a raised ICP be treated clinically?

A
  • Sedation
  • Maximise venous drainage of brain (Head of bed tilt, cervical collars)
  • CO2 control
  • Osmotic diuretics
  • CSF release
33
Q

Seizures are considered a secondary brain insult. How are these treated?

A

anti-epileptic drugs useful in early seizures but NOT for later seizures

34
Q

HOw are patients often fed after a traumatic brain/head injury?

A 
NG tube 
(this should be inserted as quickly as possible to avoid nutritional compromise)
35
Q

Steroids improve outcomes in brain injury. TRUE/FALSE?

A

FALSE
they worsen outcome
(different type of inflammation from normal)

36
Q

How is a patient confirmed “brainstem dead”?

A

Checked by 2 doctors:

  • Check no drugs are in their system
  • No hypothermia
  • No severe metabolic or endocrine disturbance
  • Complete cranial nerve exam
  • Check no respiration when off ventilator

After 2nd doctor has checked, brainstem death can be confirmed

37
Q

What symptoms can patients experience once they leave acute care and attempt to live a “normal” life again?

A
  • Seizures
  • Depression/ Mood swings/ Personality change
  • Alcohol and drug dependence
  • Failure of relationships
  • Loss of job
  • Suicide
38
Q

Give an example of a charity which supports brain injury patients after discharge?

NEUROLOGY (29 decks)

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