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Neurology > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Define a traumatic head injury

A

Non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporal or permanent impairment of cognitive, physical and psychosocial functions

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2
Q

Who is at higher of a traumatic head injury?

A
  • young men
  • elderly people
  • previous head injury
  • inner city residents
  • alcohol and drug abuse
  • low income
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3
Q

What are the potential mechanisms of traumatic head injury?

A 
Assault 
RTC 
Falls
Sports 
Over 50% involve alcohol
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4
Q

When do the most deaths due to trauma occur?

A

An hour after they happen

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5
Q

Describe the acute management of head trauma

A

Airway and C spine
Breathing
Circulation
GCS

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6
Q

What three components does GCS measure?

A

Verbal /5
Eye opening /4
Motor /6

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7
Q

In terms of GCS what are the three categories?

A
  • mild 14-15
  • moderate 9-13
  • severe 3-8
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8
Q

Who merits a CT after head injury within an hour?

A 
GCS <13 on initial assessment 
GCS <15 2 hours after injury 
Open or depressed skull fracture suspected
Signs of basal skull fracture 
Post traumatic seizure 
Focal neurological deficit 
More than one episode of vomiting 
Suspicion of NAI
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9
Q

In patients with loss of consciousness or amnesia after injury which need a CT?

A

Age 65 or above
Coagulopathy
Dangerous mechanism of injury

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10
Q

State the two types of head injury

A

Focal and diffuse

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11
Q

What are the subtypes of focal head injury?

A

Traumatic haematoma or contusion

  • extradural
  • subdural
  • intracerebral
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12
Q

What are the classic signs of a basal skull fracture?

A

Racoon eyes, battle sign (bruising of the mastoid behind the ear), CSF/blood leaking from ear, periorbital haematoma

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13
Q

What does a extradural haematoma look like on imaging?

A

It does not cross the suture line, lens shaped outside of the dura

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14
Q

How does a extradural haematoma present?

A

Injury with LOC, lucid interval of recovery followed by rapid deterioration, deteriorating GCS, hemiparesis, unilateral fixed and dilated pupil can lead to herniation and death

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15
Q

What does a subdural haematoma look like on imaging?

A

Crescent shape and can cause midline shift

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16
Q

What happens as a subdural haematoma moves from acute to chronic?

A

It liquifies, gets darker and expands - can be treated using burr holes

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17
Q

Describe diffuse axonal injury

A

Generalised global swelling, sheering forces to axons. Damage usually occurs in the brainstem or corpus collosum where density is greatest.

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18
Q

Describe excitotoxicity

A

Glutamate activates NMDA receptors causing calcium mediated activation of proteases and lipases causing further cell death

19
Q

What cytokine is high in non-survivors?

A

IL6

20
Q

State the factors that contribute to prognosis

A

Age, depth of coma, pupil reaction and motor response

21
Q

Describe decompressive craniectomy

A

Burr holes joined up to remove part of the skull so that the haematoma can be drained. Improves ICP and cerebral perfusion pressure

22
Q

How can you maximise venous drainage?

A

Set the head of the bed to 30 degrees , collars and ET tube ties

23
Q

What is the target value for carbon dioxide?

A

4.5-5, any increase will cause an increase in ICP

24
Q

State the criteria for a brainstem death

A
  • no pupil response
  • no corneal reflex
  • no motor response
  • no vestibulo-ocular reflex
  • no gag reflex
  • no cough reflex
  • no respiration
    No drugs, hypothermia or severe metabolic disturbance
25
Q

Describe decorticate posturing

A

Damage to the cerebrum, internal capsule, thalamus
Disruption of lateral corticospinal tract leads to abnormal flexion of the upper limbs (rubrospinal) and extension of lower limbs (reticulospinal)

26
Q

Describe decerebrate posturing

A

Damage below the red nucleus in the midbrain only the reticulospinal tract - extension of whole body

27
Q

What commonly causes an extradural haematoma?

A

Fracture of tempero-parietal area - middle meningeal artery

28
Q

Describe the appearance of extradural haematoma

A

Lens shape

29
Q

What can extradural haematoma lead to?

A

Midline shift and herniation

30
Q

What causes a subdural haematoma?

A

Disruption of bridging veins

  • rapid change in velocity
  • trauma in elderly patients with atrophy
31
Q

Describe the appearance of subdural haematoma

A

Crescent shape

32
Q

What happens over time to a subdural haematoma?

A

Chronic - liquifies and yellow tinge fluid may be seen due to granulation and collagen deposition

33
Q

Describe the presentation of a subarachnoid haemorrhage

A

Sudden onset severe headache, collapse, vomiting, neck stiffness, photophobia, focal neurological deficit

34
Q

What can cause a subarachnoid haemorrhage?

A

Rupture of saccular or berry aneurysm

35
Q

Name the risk factors for subarachnoid haemorrhage

A

PCKD

Collagen gene abnormalities

36
Q

What will CT of subarachnoid haemorrhage show?

A

Hyperdense material most commonly around circle of willis

37
Q

How is a subarachnoid haemorrhage managed?

A 
Rest 
Fluids
Analgesia
Anti-emetic
Treat cause
38
Q

What causes an intracerebral haemorrhage?

A

Hypertension

Aneurysm or AV malformation

39
Q

What specific types of aneurysm can occur in hypertension?

A

Charcot Bouchard micro aneurysms

Basal ganglia haematoma

40
Q

How are intracerebral haemorrhages treated?

A

Surgical evacuation

41
Q

What causes an intraventricular haemorrhage?

A

Rupture of subarachnoid or intracerebral bleed into a ventricle

42
Q

How can arteriovenous malformations present?

A

Seizures, haemorrhage, headache, steal syndrome

43
Q

How are arteriovenous malformations treated?

A

Surgery, end-vascular embolisation, stereotactic radiotherapy

Neurology (29 decks)

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