Traumatic brain injury

Question 1

What is a primary injury vs secondary injury?

Answer 1

Primary injury refers to the damage that occurs at the actual event

Secondary injury may occur anytime after the initial injury

Question 2

What is the distribution of the skull contents?

Answer 2

Brain = 80/85%
CSF = 5%
Blood = 10/15%

Question 3

What are early signs of a raised ICP?

Answer 3

Early signs
- Headache
- Vomiting
- Deterioration in GCS, pupil changes

Question 4

What are late signs of a raised ICP?

Answer 4

Late signs
- Continued deterioration in conscious level
- Abnormal flexion or extension to pain/spontaneously
- Impaired brainstem reflexes
- Increase in systolic BP and widening pulse pressure
- Bradycardia
- Slowing of respiration

Question 5

What is an extradural hematoma?

Answer 5

Blood trapped between the skull and dura, showing the classic biconvex (bow-shape). Some mid-line shift.

Question 6

What is an acute subdural hematoma?

Answer 6

Bleeding between the dura mater and the arachnoid mater
Associated with high energy impact
Venous blood – slow, insidious expansion
Found in 30% of severe TBI
Requires surgical decompression

Question 7

What is a traumatic subarachnoid haemorrhage?

Answer 7

Bleeding occurs within the subarachnoid space between the arachnoid

Question 8

What are contusions in TBI’s?

Answer 8

Bruising to the brain

Question 9

What is decompressive craniectomy?

Answer 9

If intracranial hypertension persists and medical treatments are exhausted, the removal of skull and damaged brain tissue can have a positive effect – this will only be carried out after consultant discussions that there can be a favourable outcome for the patient