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Neurology > Traumatic brain and head injury and spontaneous intracranial haemorrhage > Flashcards

Traumatic brain and head injury and spontaneous intracranial haemorrhage Flashcards

1
Q

distribution and 3 peaks of neurotrauma death

A

at time of trauma
several hours later
several days later

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2
Q

when is the golden hour

A

1st hour after trauma

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3
Q

what is traumatic brain injury

A

non-degenerative, non-congenital insult to the brain from an external mechanical force

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4
Q

what is the initial management of any trauma

A 
Airway & c-spine control 
Breathing 
Circulation 
Disability 
Everything else
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5
Q

what does the Glasgow coma scale consist of

A

eye opening
verbal response
motor response

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6
Q

what is the minimum GCS you can get

A

3

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7
Q

what is the maximum GCS you can get

A

15

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8
Q

what must you do if GCS <8

A

intubate

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9
Q

describe eye opening scoring

A

1 - none
2 - open to pain
3 - open to voice
4 - open spontaneously

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10
Q

describe voice response scoring

A 
1 - none 
2 - incomprehensible 
3 - inappropriate 
4 - confused 
5 - orientated
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11
Q

describe motor response scoring

A 
1 - none 
2 - decerebrate/extension 
3 - decorticate/abnormal flexion 
4 - withdraws to pain 
5 - localises 
6 - obeys
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12
Q

head injury severity scale
mild
moderate
severe

A

mild - 14 or 15
moderate - 9-13
severe - 3-8

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13
Q

patients with appropriate risk factors should get a CT scan within what time frame

A

within 1 hour

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14
Q

risk factors for getting a CT scan within 1 hour

A 
GCS <13 on arrival 
GCS <15 after 2 hours
suspected skull fracture 
basal skull fracture 
post traumatic seizure
focal neurological deficit 
>1 episode of vomiting 
NAI suspicion in children
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15
Q

CT should also be requested if patients have amnesia and what other risk factors

A

age >65
coagulopathy
dangerous mechanism of injury

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16
Q

what are signs of base of skull fracture

A

raccoon eyes / peri orbital haematoma
battles sign / bruise behind ear
blood or CSF from ear

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17
Q

where is blood in an extradural haematoma

A

bone and dura

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18
Q

describe findings of extradural haematoma on imaging

A

bright white - blood on CT

lens/biconvex shape because dura is fixed to skull at suture lines

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19
Q

describe clinical characteristics of extradural haematoma

A

head injury and initial loss of consciousness
recover with no deficits - “lucid interval”
then sudden rapid deterioration of neurological deficit - deteriorating GCS, unilateral fixed and dilated pupil, apnoea and death

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20
Q

classification of subdural haematomas

A

acute

chronic

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21
Q

where is blood in a subdural haematoma

A

dura and arachnoid

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22
Q

describe findings of acute + chronic subdural haematomas on imaging

A

crescent shaped
acute - bright white/hyperdense
chronic - dark/isodense

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23
Q

what vessel is damaged in extradural haematoma

A

middle meningeal artery

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24
Q

what vessels are damaged in subdural haematoma

A

bridging cerebral veins

25
Q

what is diffuse axonal injury and how severe is it

A

brain swelling from stretching, shearing and twisting of axons
excitotoxicity and apoptosis
devastating injury

26
Q

where does diffuse axonal injury occur

A

grey white matter interface

27
Q

MAP - ICP = ?

A

CPP cerebral perfusion pressure

28
Q

medical management of raised ICP

A 
sedation - propofol, BZDs, barbiturates
maximise brain venous drainage
tilt head of bed at 30 degrees
CO2 control - 4.5kPa
osmotic diuretics - mannitol 
CSF release - shunt, drain
29
Q

as PCO2 increases, CPP increases/decreases

A

increases

30
Q

what is the last resort in management of ^ICP

A

decompressive craniectomy

31
Q

how should nutrition be delivered

A

NG tube ASAP

32
Q

steroids are beneficial/harmful in head injury resulting in swelling eg DAI

A

harmful

33
Q

what is it important to rule out when confirming brainstem death

A

every other option has been exhausted
no anaesthetics, recreational or sedative drugs
no hypothermia or severe metabolic disturbances

34
Q

how do you diagnose brainstem death

A 
assessment repeated twice:
no pupil response 
no corneal reflex 
no gag reflex 
no vestibulo-ocular reflex 
no motor response 
no respiration
35
Q

who can diagnose brainstem death

A

need 2 doctors both registered for at least 5 years

1 of whom is a consultant

36
Q

when is time of death confirmed

A

after completion of first set of tests

2nd round is just for confirmation

37
Q

how should patients be followed up after acute management

A 
seizures
depression 
alcohol and drugs 
personality changes 
aggression 
suicide 
financial and jobs
38
Q

where does bleeding in subarachnoid haemorrhage occur SAH

A

between arachnoid and pia mater in the subarachnoid space

39
Q

how does SAH present

A 
thunderclap headache 
sudden onset severe headache 
meningismus
collapse
vomiting
photophobia
40
Q

differential diagnosis of sudden onset severe headache

A

SAH
migraine
cluster headache
benign coital cephalgia

41
Q

which investigations should be done for SAH

A

CT
LP
CTA

42
Q

causes of SAH

A

berry aneursym
trauma
AVM
idiopathic

43
Q

how can you tell a SAH from imaging

A

blood appears white so there is white in the subarachnoid space ie where the ventricles are

44
Q

role of LP in SAH

A

if CT scan is negative for SAH, LP is done if there is no focal neurological deficit or ^ICP

45
Q

wait 12 hours before doing a LP, true or false

A

false, despite NICE guidelines do a LP as soon as

take 3 samples so that the last sample has less blood in case of traumatic tap

46
Q

CSF findings in SAH

A

xanthochromatic CSF

yellow staining from RBC breakdown

47
Q

which investigation is gold standard in SAH

A

CT angiogram

48
Q

list complications of SAH

A 
rebleeding 
delayed ischaemic neurological deficit 
hydrocephalus
hyponatraemia
seizures
49
Q

what can be done to prevent rebleeding in SAH

A

endovascular techniques and surgical clipping

50
Q

when is the highest risk of delayed ischaemic neurological deficit after SAH

A

3-12 days post SAH

51
Q

what can be given to improve outcome and prevent cerebral ischaemia after SAH

A

PO/IV nimodipine (CCB)

52
Q

what is triple H therapy and what is it used for

A 
management of delayed ischaemic neurological deficit
try to induce:
hypertension
hypervolaemia
haemodilution
53
Q

how does hydrocephalus present as a complication of SAH

A

increasing headache after 1 week

54
Q

causes of hyponatraemia after SAH and its management

A

SIADH
cerebral salt wasting
fludrocortisone

55
Q

any brain injury lowers the seizure threshold, true or false

A

true

56
Q

what is intracerebral haemorrhage

A

bleeding into the brain parenchyma

57
Q

causes of intracerebral haemorrhage ICH

A

HTN
aneurysm
AVM

58
Q

presentation of ICH

A

headache
focal neurological deficit
decreased conscious level

59
Q

management of ICH

A

surgical evacuation of haematoma

or non-surgical management - same as haemorrhagic stroke

Neurology (25 decks)

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