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Yr 4 - PassMed Corrections > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Are CT’s contrast or non-contrast in head injury?

A

Non-contrast

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2
Q

Steps in CT interpretation?

A

1) Name & DOB

2) When was scan done?

3) Previous CTs to compare?

4) Is falx cerebri (line in middle) in a straight line?

5) What do ventricles look like?

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3
Q

Black vs white on CT?

A

Black - low density (air)

White - high density (blood, bone)

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4
Q

Acute vs chronic bleediong?

A

Acute - hyperdense (white)

Chronic - hypodense (dark grey)

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5
Q

What are the 2 overall types of intracranial haemorrhages?

A

1) Extra-axial:
- extradural
- subdural
- subarachnoid

2) Intra-axial:
- intraparenchymal
- intraventricular

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6
Q

Location of extradural haemorrhage?

A

Collection of blood between skull and dura mater

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7
Q

Typical cause of extradural haemorrhage?

A

Low impact trauma, typically to temporal region (pterion).

Rupture of middle meningeal artery.

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8
Q

Presentation of extradural

A

1) General: headache, N&V, progressive drowsiness

2) Lucid interval

3) Fixed dilated pupil (due to CN III palsy)

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9
Q

CT findings in extradural haemorrhage?

A
  • Hyperdense = acute
  • Mass effect possible (shift of midline)
  • Biconvex/lentiform shape
  • Limited by suture lines of skull
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10
Q

Mx of extradural haemorrhage?

A

Neurosurgical opinion –> conservative or surgical

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11
Q

Location of subdural haemorrhage?

A

Deep to the dura mater of the meninges and superficial to the arachnoid mater.

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12
Q

Acute vs chronic subdural haemorrhage?

A

Acute: develops within 48h of injury

Chronic: develops over 3 weeks

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13
Q

What are some behavioural features seen in subdural haemorrhage?

A

Memory loss, personality changes, cognitive impairment.

Can mimic dementia.

Fluctuating over weeks/months.

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14
Q

Mechanism of injury in acute subdural haemorrage?

A

High impact trauma

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15
Q

CT findings in acute subdural haemorrhage?

A
  • HYPERdense (acute bleed)
  • Mass effect possible
  • Crescent shaped collection
  • NOT limited by suture lines
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16
Q

Important to consider in patient history with any head injury?

A

Are they on any anticoagulants?

17
Q

Cause of chronic subdural haemorrage?

A

Rupture of small bridging veins (between venous sinus & cortex)

18
Q

Risk factors for chronic subdural haemorrhage?

A

Eldery, alcohol abuse

19
Q

CT findings in chronic subdural haemorrhage?

A
  • HYPODense
  • Midline shift possible
  • Crescent shaped collection
  • Not limited by suture lines
20
Q

CT findings in acute on chronic subdural haemorrhage?

A
  • Hypodense
  • Hyperdense
  • Midline shift possible
  • Crescent shaped collection
  • Not limited by suture lines

i.e. both

21
Q

Mx step in all traumatic brain injuries?

A

Referral to neurosurgery

22
Q

What is the most important initial treatment in SAH?

A

Nimodipine

23
Q

Role of nimodipine in SAH?

A

Prevent vasospasm (can lead to ischaemia)

24
Q

Location of SAH?

A

Between pia and arachnoid membranes

25
Q

What is the subarachnoid space normally occupied by?

A

CSF

26
Q

What is most common cause of spontaneous SAH?

A

Saccular (berry) aneurysm

27
Q

Risk factors for berry aneurysms?

A
  • FHx
  • Female
  • African descent
  • PKD
  • Connective tissue disorders
28
Q

3 key ECG findings in SAH?

A

1) Tall peaked T waves
2) ST depression
3) Prolonged QT

29
Q

CT findings in SAH?

A
  • Hyperdense
  • Distributed in cisterns and sulci
  • Intraventricular involvement
30
Q

Stepwise investigations in SAH?

A

1) Non-contrast CT head
a) If positive –> diagnose SAH
b) If negative <6h after bleed –> think about other diagnoses
c) If negative >6h after bleed –> consider LP

2) LP at least 12 hours after symptoms onset:
a) If negative –> thhink about other diagnoses
b) if positive (elevated bilirubin/xanthochroma) –> diagnose SAH

3) Get CT angiography of head

31
Q

Mx of vasospasm in SAH?

A

Nimodipine

32
Q

What electrolyte abnormality is common in SAH?

A

Hyponatraemia

33
Q

Mx of seizures in SAH?

A

Prophylactic levetiracetam

34
Q

Mx of hydrocephalus in SAH?

A

Drain/shunt

35
Q

Mx of re-bleeding in SAH?

A

Regular neuro obs
Repeat CT

36
Q

Head injury rules: CT <1 hour?

A

1) GCS <13 on initial assessment

2) GCS <15 2 hours post-injury

3) Suspected open or depressed fracture

4) Basal skull fracture

5) Post-traumatic seizure

6) Focal neuro deficit

7) >1 episode of vomiting

37
Q

Head injury rules: CT <8 hours?

A

1) Warfarinised

2) LOC/amnesia +
- 65+ years
- bleeding/clotting disorder (or anticoagulants)
- dangerous mechanism of injury
- >30 mins retrograde amnesia

38
Q
A

Yr 4 - PassMed Corrections (36 decks)

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