Week 4: Intro to Neurotrauma Flashcards
In neuro trauma, the most important part of the cranial CT
scan to assess is
if there is midline shift.
Why there a need to assess if there is a midline shift?
The structures that lie within the midline are parts of your
thalamus, parts of your brain stem but more importantly the
Ascending Reticular Activating System.
Easier way to assess midline shift is to
draw a straight light from the falx
and measure the distance from the midline.
what is the significant value in assessing the midline shift?
Anything
greater than 6mm or 0.6cm is deadly. It is significant, it
has a 66% mortality rate.
What are the indications for surgery for fractures if it is
depressed?
If it is depressed there is greater likelihood that the
dura is perforated or lacerated. If the dura is lacerated
there is communication between the external
environment and the brain. So there is a 37% chance
of meningitis. So you need to do surgery on that.
There is significant pneumocephalus greater than 1cm. so maari magkaroon ng Tension Pneumocephalus.
If there is an underlying hematoma that is surgical
A female with cosmetic defect.
is commonly seen in neurosurgical patients following head trauma or following intracranial surgery
Pneumocephalus
occurs when the intracranial air pocket is under tension which can result in life threatening herniation if left untreated
Tension pneumocephalus
Indications for surgery in epidural hematomas?
If it is greater than 30cc there is significant midline shift and it is 15 mm thick
If the patient has anisocoria. If you have anisocoria your CN III, mid brain, ascending reticular activating system are compress. Do surgery STAT.
30 cc is the magic number. Everything 30cc kapag sa brain it is surgical.
It is hematoma between the skull and the dura. Remember the brain is not affected but it can cause significant midline shift.
accumulation of blood between the skull and the dura.
usually results from arterial disruption, especially of the middle meningeal artery
Epidural hematoma
Epidural hematomas have hihger mortality rate compared to your subdural hematoma. T or F?
F. Lower
The patient is initially unconscious from the concussive aspect of the head trauma. The patient then awakens and has a “lucid interval,” while the hematoma subclinically expands. As the volume of the hematoma grows, the decompensated region of the pressure volume curve is reached, ICP increases, and the patient rapidly becomes lethargic and herniates.
Epidural hematoma`
is the result of an accumulation of blood between the arachnoid membrane and the dura.
usually results from venous bleeding, typically from tearing of a bridging vein running from the cerebral cortex to the dural sinuses.
Subdural hematomas
crescent shaped lesions
subdural hematomas
it possess a higher mortality rate 50% and they have significant midline shift.
Subdural hematomas
is a collection of blood breakdown products that is at least 2 to 3 weeks old. Acute hematomas are bright white (hyperdense) on CT scan for approximately 3 days, after which they fade to isodensity with brain, and then to hypodensity after 2 to 3 weeks.
Chronic SDH
