Traumatic brain and head injury and spontaneous intracranial haemorrhage Flashcards by Hiba Alhasso

distribution and 3 peaks of neurotrauma death

at time of trauma
several hours later
several days later

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when is the golden hour

1st hour after trauma

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what is traumatic brain injury

non-degenerative, non-congenital insult to the brain from an external mechanical force

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what is the initial management of any trauma

Airway &amp; c-spine control 
Breathing 
Circulation 
Disability 
Everything else

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what does the Glasgow coma scale consist of

eye opening
verbal response
motor response

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what is the minimum GCS you can get

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what is the maximum GCS you can get

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what must you do if GCS <8

intubate

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describe eye opening scoring

1 - none
2 - open to pain
3 - open to voice
4 - open spontaneously

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describe voice response scoring

1 - none 
2 - incomprehensible 
3 - inappropriate 
4 - confused 
5 - orientated

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describe motor response scoring

1 - none 
2 - decerebrate/extension 
3 - decorticate/abnormal flexion 
4 - withdraws to pain 
5 - localises 
6 - obeys

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head injury severity scale
mild
moderate
severe

mild - 14 or 15
moderate - 9-13
severe - 3-8

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patients with appropriate risk factors should get a CT scan within what time frame

within 1 hour

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risk factors for getting a CT scan within 1 hour

GCS <13 on arrival 
GCS <15 after 2 hours
suspected skull fracture 
basal skull fracture 
post traumatic seizure
focal neurological deficit 
>1 episode of vomiting 
NAI suspicion in children

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CT should also be requested if patients have amnesia and what other risk factors

age >65
coagulopathy
dangerous mechanism of injury

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what are signs of base of skull fracture

raccoon eyes / peri orbital haematoma
battles sign / bruise behind ear
blood or CSF from ear

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where is blood in an extradural haematoma

bone and dura

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describe findings of extradural haematoma on imaging

bright white - blood on CT

lens/biconvex shape because dura is fixed to skull at suture lines

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describe clinical characteristics of extradural haematoma

head injury and initial loss of consciousness
recover with no deficits - “lucid interval”
then sudden rapid deterioration of neurological deficit - deteriorating GCS, unilateral fixed and dilated pupil, apnoea and death

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classification of subdural haematomas

acute

chronic

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where is blood in a subdural haematoma

dura and arachnoid

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describe findings of acute + chronic subdural haematomas on imaging

crescent shaped
acute - bright white/hyperdense
chronic - dark/isodense

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what vessel is damaged in extradural haematoma

middle meningeal artery

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what vessels are damaged in subdural haematoma

Study These Flashcards

bridging cerebral veins

what is diffuse axonal injury and how severe is it

brain swelling from stretching, shearing and twisting of axons excitotoxicity and apoptosis devastating injury

where does diffuse axonal injury occur

grey white matter interface

MAP - ICP = ?

CPP cerebral perfusion pressure

medical management of raised ICP

``` sedation - propofol, BZDs, barbiturates maximise brain venous drainage tilt head of bed at 30 degrees CO2 control - 4.5kPa osmotic diuretics - mannitol CSF release - shunt, drain ```

as PCO2 increases, CPP increases/decreases

increases

what is the last resort in management of ^ICP

decompressive craniectomy

how should nutrition be delivered

NG tube ASAP

steroids are beneficial/harmful in head injury resulting in swelling eg DAI

harmful

what is it important to rule out when confirming brainstem death

every other option has been exhausted no anaesthetics, recreational or sedative drugs no hypothermia or severe metabolic disturbances

how do you diagnose brainstem death

``` assessment repeated twice: no pupil response no corneal reflex no gag reflex no vestibulo-ocular reflex no motor response no respiration ```

who can diagnose brainstem death

need 2 doctors both registered for at least 5 years | 1 of whom is a consultant

when is time of death confirmed

after completion of first set of tests | 2nd round is just for confirmation

how should patients be followed up after acute management

``` seizures depression alcohol and drugs personality changes aggression suicide financial and jobs ```

where does bleeding in subarachnoid haemorrhage occur SAH

between arachnoid and pia mater in the subarachnoid space

how does SAH present

``` thunderclap headache sudden onset severe headache meningismus collapse vomiting photophobia ```

differential diagnosis of sudden onset severe headache

SAH migraine cluster headache benign coital cephalgia

which investigations should be done for SAH

CT LP CTA

causes of SAH

berry aneursym trauma AVM idiopathic

how can you tell a SAH from imaging

blood appears white so there is white in the subarachnoid space ie where the ventricles are

role of LP in SAH

if CT scan is negative for SAH, LP is done if there is no focal neurological deficit or ^ICP

wait 12 hours before doing a LP, true or false

false, despite NICE guidelines do a LP as soon as | take 3 samples so that the last sample has less blood in case of traumatic tap

CSF findings in SAH

xanthochromatic CSF | yellow staining from RBC breakdown

which investigation is gold standard in SAH

CT angiogram

list complications of SAH

``` rebleeding delayed ischaemic neurological deficit hydrocephalus hyponatraemia seizures ```

what can be done to prevent rebleeding in SAH

endovascular techniques and surgical clipping

when is the highest risk of delayed ischaemic neurological deficit after SAH

3-12 days post SAH

what can be given to improve outcome and prevent cerebral ischaemia after SAH

PO/IV nimodipine (CCB)

what is triple H therapy and what is it used for

``` management of delayed ischaemic neurological deficit try to induce: hypertension hypervolaemia haemodilution ```

how does hydrocephalus present as a complication of SAH

increasing headache after 1 week

causes of hyponatraemia after SAH and its management

SIADH cerebral salt wasting fludrocortisone

any brain injury lowers the seizure threshold, true or false

true

what is intracerebral haemorrhage

bleeding into the brain parenchyma

causes of intracerebral haemorrhage ICH

HTN aneurysm AVM

presentation of ICH

headache focal neurological deficit decreased conscious level

management of ICH

surgical evacuation of haematoma | or non-surgical management - same as haemorrhagic stroke

Traumatic brain and head injury and spontaneous intracranial haemorrhage Flashcards

(59 cards)