TRAUMATIC BRAIN INJURY Flashcards
What is TBI?
- non-degenerative, non-congenital INSULT to the brain from an EXTERNAL mechanical force
> temporary/permanent impariment of COGNITIVE/PHYSICAL/ PSYCHOSOCIAL fxns
Who is at risk of TBI?
- young men and elderly
- previous head injuries
- inner cities residents
- alcohol and DRUG abuse
- low-income
What political stances made for preventing TBI?
- seatbelt laws (‘83)
- testing for drink driving (‘83)
- helmets
How to manage a pt coming in with a TBI?
- atls managment (ABCs) —-GCS/ PUPILS/ other
- Secondary survey (check for other injuries) –c-spine
- HX (what happened/ when/ age/ PMH/ DRUGS- anticoagulants)
When must CT scans be performed WITHIN 1 hr of head injury?
- GCS <13 at ED
- gcs <15 AT 2HRS after injury
- suspected skull # (open/depressed)
- basal skull #
- post traumatic seizure
- focal NEUROLOGICAL deficit
- more than one episode of VOMITING
- SUSPICION of NAI (non-accidental injury)
Special request for CT scan in pts if they experience LOC or amnesia since the injury?
- > 65y.o
- coagulopathy
- dangerous mechanism of INJURY (MVA/ fall from a height > 1m)
- MORE than 30 mins of RETROGRADE amnesia of events before the injury
What is a sign of BASILAR skull fracture?
BATTLE’S sign
- crescent shaped bruise that appears behind ONE or BOTH ears
What are other signs of basilar skull fracture?
- bruising around the eyes
- anosmia
- hearing problems
- fluid/ blood leaking from ears/nose
What form of posturing is found in cerebral hemorrhage damage?
decorticate posturing –FLEXION of arms in wards (like mummy)
—-as red nucleus is still functioning
(nucleus relays flexor info)
What form of posturing is seen with brain stem damage?
- decerebrate posturing
EXTENSION of arms—no red nucleus fxn
What is subfalcine herniation?
when the Cingulate gyrus HERNIATES under the FALX cerebri
to the OTHER side
How does subfalcine herniation present as?
- ACA compression as the ACA gets dragged to the other side
- c/l hemiparesis of the LEG
What occurs in UNCAL herniation
- medial temporal lobe crosses over the tentorium cerebelli
> COMPRESSES MIDBRAIN
How does an epidural hematoma usually occur?
- # of pterion bone o> rupture of MIDDLE meningeal artery
How does Epidural hematoma present on CT?
- CONVEX shape
(LEMON) - because can’t cross suture lines (dura attached to the sutures)
What is the clinical course of the epidural hematoma?
- Initial loss of consciousness, immediately after the trauma
- temporary recovery of consciousness (LUCID interval)
- Renewed decline in MENTAL status- rapid
SYMPTOMS which may appear AFTER the trauma or after a LUCID interval
- deteriorating GCS
- possible HEMIPARESIS
- u/l FIXED and DILATED pupil
- apnoea and death
How does subdural hematoma occur?
- rupture of BRIDGING veins
- blood b/w DURA and arachnoid mater
How diff. is the onset of symptoms in Subdural hematoma as opposed to extradural?
- SLOW bleed in SUBDURAL hematoma d.t rupture of low pressure veins
Who is at risk of subdural hematoma?
- old age (Brain atrophy)
- alcoholics
- those on BLOOD THINNERS
When is the onset of symptoms in Subdural hemorrhage?
- confusion WEEKS AFTER head injury
What is subarachnoid hemorrhage?
- bleeding between the PIA and ARACHNOID mater
How does subarachnoid hemorrhage present as?
- worst headache of my life
- SUDDEN onset
- FEVER and nuchal rigidity
- Photophobia
- focal neurological deficits
How to confirm dx of subarachnoid hemorrhage?
- CT
- blood stained or xanthochromic (6-48 hrs) CSF spinal tap
What causes subarachnoid hemorrhage?
- ruptured BERRY aneurysm
- –esp. at anterior circle of WILLIS (branch points of AComm artery)
