Traumatic Brain Injury Flashcards

1
Q

Describe the pathophysiology of a subdural haemorrhage.

A

Occurs usually as a result of high-impact trauma, causing rupture on the bridging veins

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2
Q

Describe the presentation of an acute subdural haemorrhage.

A

Varies depending on the extent of bleeding - can range from incidental finding on CT or severe coma and coning.

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3
Q

What is first-line imaging for a head injury?

A

Non-contrast CT head

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4
Q

How does acute subdural haemorrhage appear on CT?

A

A hyperdense, crescentic lesion which is not limited by suture lines

A large haemorrhage could also cause mass effect, midline shift, and herniation

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5
Q

What is the management of acute subdural haemorrhage?

A

Small, incidental acute subdurals can be managed conservatively.

More severe and symptomatic acute subdurals may require emergency trauma craniotomy with a large flap for haematoma evacuation.
Cerebral swelling may require frontal or temporal lobectomy for decompression and bone flap removal.

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6
Q

Describe the presentation of chronic subdural haemorrhage.

A

Usually an elderly person or alcoholic.

Suspect chronic subdural in any individual with week-months history of fluctuating confusion, reduced consciousness, or neurological deficit.

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7
Q

How does chronic subdural haemorrhage appear on CT?

A

A hypodense, crescentic lesion which is not limited by suture lines.

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8
Q

What is the management for chronic subdural haemorrhage?

A
  • Conservative management
  • Non-surgical: dexamethasone 2mg TDS
  • Surgical: haematoma evacuation via craniotomy or decompression with burr holes
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9
Q

Describe the pathophysiology of a extradural haemorrhage.

A

Usually occurs following low-impact trauma to the temporal area of the skull/pterion causing rupture of the middle meningeal artery.

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10
Q

Describe the typical presentation of extradural haemorrhage.

A

Typically younger people
“Walk and die”

Initially, brief loss of consciousness (~30s), followed by a lucid period and then a rapid decline in GCS

May have fixed, dilated pupils

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11
Q

Why might a person with EDH have fixed, dilated pupils?

A

Expansion of the haematoma causes compression of the parasympathetic fibres of CN III

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12
Q

How does EDH appear on CT head?

A

A hyperdense, biconvex lesion which does not cross suture lines

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13
Q

How should EDH be managed?

A

Usually considered a neurosurgical emergency

Burr hole over pterion, followed by craniotomy and evacuation of haematoma

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14
Q

Describe the pathophysiology of a subarachnoid haemorrhage.

A

Sudden rupture of an intracranial (berry) aneurysm, rupture of AVMs, pituitary apoplexy, or trauma

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15
Q

Which conditions are associated with an increased risk of SAH?

A

Any condition associated with berry aneurysms:

  • ADPKD
  • Ehlers-Danlos syndrome
  • Aortic coarctation
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16
Q

How does SAH usually present?

A
  • Thunderclap headache
  • Meningism –> headache, photophobia, neck stiffness
  • N+V
  • Seizures
  • Coma
17
Q

How does SAH appear on CT head?

A

“Star sign” - hyperdensities within the basal cisterns, sulci, and ventricular systems

18
Q

If CT head is negative for SAH, what investigation should be performed?

A

LP at 12 hours following symptom onset.

Looking for xanthochromia (RBC breakdown)

19
Q

How should SAH be managed?

A
  • Interventional neuroradiologist: coiling
  • Neurosurgery: clipping
  • 21-day course of nimodipine
20
Q

What is nimodipine and why is it given in SAH?

A
  • CCB

- Given to prevent vasospasm and rebleeding following SAH

21
Q

What are the potential complications of SAH?

A
  • Rebleeding (most common in first 12h)
  • Vasospasm
  • Hyponatraemia –> SIADH
  • Seizure
  • Hydrocephalus
  • Death
22
Q

What are the indications for immediate CT head (adults)?

A
  • GCS <13
  • GCS <15 2 hours from injury
  • Suspected open or depressed skull fracture
  • Signs of basal skull fracture
  • Post-traumatic seizures
  • Focal neurological deficit
  • > 1 episode of vomiting
  • Bleeding disorder/anticoagulation
23
Q

What are the indications for CT head within 8h (adults)?

A
  • Amnesia or LOC (and none of the immediate CT indications)
  • Age >65 years
  • Dangerous mechanism of injury
24
Q

What are the criteria for admitting head injury patients to hospital?

A
  • New abnormalities on imaging
  • GCS <15 (even if imaging is normal)
  • Persistent vomiting or severe headache
  • Fits criteria for CT head at 8 hours
  • Any other concerns such as drugs, alcohol intoxication, other injuries, shock, meningism, CSF leak, non-accidental injury