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Neurology > Head Trauma > Flashcards

Flashcards in Head Trauma Deck (43):
1

who are at high risk of head injuries

young men and elderly
previous head injuries
residents of inner cities
alcohol and drug abuse
low income

2

what do over half of head injuries involve

alcohol

3

when do most deaths occur after head injury

within first hour
then peak at 7 hours- secondary effects
3rd peak later due to medical complications- high risk of pneumonia, DVT, PE

4

what are the components of the glasgow coma scale

eye opening (4-1)
- spontaneously
-to speech
-to pain
-none

verbal (5-1)
-orientated
-confused
-inappropriate
-incomprehensible
-no verbal

motor (6-1)
-obeying
-moves to localised pain
-flexion withdrawal from pain
-abnormal flexing (decorticate)
-abnormal extension (decerebrate)
-no motor response

5

which part of glasgow coma scale carries most significance

motor

6

what are the best and worst GCS scores

best 15
worst 3

7

when is a patient comatosed on GCS

8 or less

8

what are the parameters for head injury severity on GCS score

14/15, brief LOC= mild
9-13 = moderate
3-8= severe

9

patients with what risk factors should have a CT scan done within 1 hour of being identified

GCS< 13 on initial assessment
GCS< 15 2 hours after injury
suspected open/ depressed skull fracture
any sign of basal skull fracture
post traumatic seizure
focal neurological deficit
more than one episode of vomiting
suspicion of NAI

10

who should get a CT if they experienced some LOC or amnesia since the injury

>65
coagulopathy (medically induced or thrombophilia)
dangerous mechanism of injury

11

what does lacunar eyes mean

basilar skull fracture

12

what is battles sign

bruising over the mastoid - basilar skull fracture

13

what does any blood in CSF suggest

basilar skull #

14

what is DAI (found in CT in diffuse head injury)

diffuse axonal injury

15

what are the possible CT findings in a focal head injury

traumatic haemorrhage- extradural, subdural, intracerebral
contusion

16

what are the features of an extradural haematoma

blood cant cross suture lines - fills space
lens shape/ biconvex shape
more common in younger patients

17

what is the usual presentation of an extradural haematoma

injury with LOC
has lucid interval in recovery
rapid progression of neurological symptoms
-deteriorating GCS
-possible hemiparesis/ wekaness
-unilateral fixed and dilated pupil
-apnoea and death

18

what are the features of an acute subdural haematoma

more common in elderly
brain atrophy
bridging veins disrupted
will be hyPERdense

19

what will a chronic subdural haematoma look like on imaging

hyPOdense

20

what is an intracerebral haemoatoma

blood clot within the brain

21

what is coup and contra-coup

coup- brain hits side of head that is impacted
contra coup- brian hits opposite side

22

what causes a diffuse axonal injury

large shearing forces

23

what is the neurosurgical role in head injury

prevent secondary insults
-hypoxia
-hypotension
-mass lesions
-controlling ICP and CPP (cerebral perfusion pressure)

24

what formula calculated cerebral perfusion pressure

MAP - ICP

25

what maintains good cerebral perfusion pressure

maintained MAP (up) and ICP (down) at right levels

26

what are the basal cisterns

compartments within the subarachnoid space where the pia mater and arachnoid membrane are not in close approximation and cerebrospinal fluid (CSF) forms pools or cisterns

mass have vessels/ nerves running through them

27

what does closure of the basal cisterns do

increases ICP

28

how is ICP monitored

wire inserted into head

29

what is the medical management for raised ICP

sedation- propofol, benzodiazepines, barbiturates
maximise venous drainage of brain - head tilt of bed (30 degrees), cervical collars, ET tube ties
co2 control
osmotic diuretics - mannitol, hypertonic saline
CSF release- external ventricular drain

30

how does CO2 affect ICP

if CO2 is too high cerebral blood flow increases- increasing ICP

31

what happens if arterial CO2 drops too low

reduce blood flow to brain by too much

32

what is a decompressive craniectomy and when is it done

after all medical management of raised ICP is exhausted
take off part of cranium
saves lives but doesnt improve outcomes

33

why do BP changes have such a big impact in head injury

as lose autoregulation, will directly impact cerebral blood flow

34

why is nutrition important in head injury

need to feed patients NG early on

if not fed in 5-7 days after injury increase likelihood of death and mortality rate

35

why do axons swell up in DAI

as the injury (stretched, sheared, twisted or compressed) allows more ions and water into the axon

36

where do DAIs happen

where density difference is the greatest (grey/white interface)

37

what happens after DAI

excitotoxicity and apoptosis
inflammatory mediator (cytokines, interleukins) response
neuronal death

38

what is excitotoxicity

excitatory amino acids (gutamate) activates NMDA receptors
calcium mediated activation of proteases and lipases
cell death

39

do steroids help in head injuries

no- causes toxic swellings

40

what symptoms and signs suggest brainstem death

no pupil response
no corneal reflex
no gag reflex
no vestibulo-ocular reflex (project cold water into one ear and look at eye movement)
no motor response
no respiration

41

what is the apnoea test

to look for brainstem death
Pre-oxygenate to look for a change in Co2 levels. Disconnect the ventilator and check pCO2 which must rise to 6 pKa

42

what are the possible long term complications of a head injury

Seizures
Depression
Alcohol and drug dependence
Personality change
Mood swings
Aggression
Recurrent behaviour – further head injuries
Failure of relationships
Loss of job
suicide

43

what is ATLS

advanced trauma life support
-airway with C spine control
-breathing
-circulation