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Neurology > Head Trauma > Flashcards

Head Trauma Flashcards

(43 cards)

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1
Q

who are at high risk of head injuries

A 
young men and elderly 
previous head injuries 
residents of inner cities
alcohol and drug abuse 
low income
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2
Q

what do over half of head injuries involve

A

alcohol

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3
Q

when do most deaths occur after head injury

A

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

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4
Q

what are the components of the glasgow coma scale

A

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
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5
Q

which part of glasgow coma scale carries most significance

A

motor

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6
Q

what are the best and worst GCS scores

A

best 15

worst 3

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7
Q

when is a patient comatosed on GCS

A

8 or less

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8
Q

what are the parameters for head injury severity on GCS score

A

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

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9
Q

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

A 
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
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10
Q

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

A

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

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11
Q

what does lacunar eyes mean

A

basilar skull fracture

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12
Q

what is battles sign

A

bruising over the mastoid - basilar skull fracture

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13
Q

what does any blood in CSF suggest

A

basilar skull #

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14
Q

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

A

diffuse axonal injury

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15
Q

what are the possible CT findings in a focal head injury

A

traumatic haemorrhage- extradural, subdural, intracerebral

contusion

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16
Q

what are the features of an extradural haematoma

A

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

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17
Q

what is the usual presentation of an extradural haematoma

A 
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
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18
Q

what are the features of an acute subdural haematoma

Study These Flashcards
A

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

19
Q

what will a chronic subdural haematoma look like on imaging

20
Q

what is an intracerebral haemoatoma

Study These Flashcards
A

blood clot within the brain

21
Q

what is coup and contra-coup

Study These Flashcards
A

coup- brain hits side of head that is impacted

contra coup- brian hits opposite side

22
Q

what causes a diffuse axonal injury

Study These Flashcards
A

large shearing forces

23
Q

what is the neurosurgical role in head injury

Study These Flashcards
A

prevent secondary insults

  • hypoxia
  • hypotension
  • mass lesions
  • controlling ICP and CPP (cerebral perfusion pressure)
24
Q

what formula calculated cerebral perfusion pressure

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

Neurology (35 decks)

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