Traumatic brain and head injury and spontaneous intracranial haemorrhage Flashcards Preview

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Flashcards in Traumatic brain and head injury and spontaneous intracranial haemorrhage Deck (59):
1

distribution and 3 peaks of neurotrauma death

at time of trauma
several hours later
several days later

2

when is the golden hour

1st hour after trauma

3

what is traumatic brain injury

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

4

what is the initial management of any trauma

Airway & c-spine control
Breathing
Circulation
Disability
Everything else

5

what does the Glasgow coma scale consist of

eye opening
verbal response
motor response

6

what is the minimum GCS you can get

3

7

what is the maximum GCS you can get

15

8

what must you do if GCS <8

intubate

9

describe eye opening scoring

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

10

describe voice response scoring

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

11

describe motor response scoring

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

12

head injury severity scale
mild
moderate
severe

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

13

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

within 1 hour

14

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

15

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

age >65
coagulopathy
dangerous mechanism of injury

16

what are signs of base of skull fracture

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

17

where is blood in an extradural haematoma

bone and dura

18

describe findings of extradural haematoma on imaging

bright white - blood on CT
lens/biconvex shape because dura is fixed to skull at suture lines

19

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

20

classification of subdural haematomas

acute
chronic

21

where is blood in a subdural haematoma

dura and arachnoid

22

describe findings of acute + chronic subdural haematomas on imaging

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

23

what vessel is damaged in extradural haematoma

middle meningeal artery

24

what vessels are damaged in subdural haematoma

bridging cerebral veins

25

what is diffuse axonal injury and how severe is it

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

26

where does diffuse axonal injury occur

grey white matter interface

27

MAP - ICP = ?

CPP cerebral perfusion pressure

28

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

29

as PCO2 increases, CPP increases/decreases

increases

30

what is the last resort in management of ^ICP

decompressive craniectomy

31

how should nutrition be delivered

NG tube ASAP

32

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

harmful

33

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

34

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

35

who can diagnose brainstem death

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

36

when is time of death confirmed

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

37

how should patients be followed up after acute management

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

38

where does bleeding in subarachnoid haemorrhage occur SAH

between arachnoid and pia mater in the subarachnoid space

39

how does SAH present

thunderclap headache
sudden onset severe headache
meningismus
collapse
vomiting
photophobia

40

differential diagnosis of sudden onset severe headache

SAH
migraine
cluster headache
benign coital cephalgia

41

which investigations should be done for SAH

CT
LP
CTA

42

causes of SAH

berry aneursym
trauma
AVM
idiopathic

43

how can you tell a SAH from imaging

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

44

role of LP in SAH

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

45

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

46

CSF findings in SAH

xanthochromatic CSF
yellow staining from RBC breakdown

47

which investigation is gold standard in SAH

CT angiogram

48

list complications of SAH

rebleeding
delayed ischaemic neurological deficit
hydrocephalus
hyponatraemia
seizures

49

what can be done to prevent rebleeding in SAH

endovascular techniques and surgical clipping

50

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

3-12 days post SAH

51

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

PO/IV nimodipine (CCB)

52

what is triple H therapy and what is it used for

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

53

how does hydrocephalus present as a complication of SAH

increasing headache after 1 week

54

causes of hyponatraemia after SAH and its management

SIADH
cerebral salt wasting
fludrocortisone

55

any brain injury lowers the seizure threshold, true or false

true

56

what is intracerebral haemorrhage

bleeding into the brain parenchyma

57

causes of intracerebral haemorrhage ICH

HTN
aneurysm
AVM

58

presentation of ICH

headache
focal neurological deficit
decreased conscious level

59

management of ICH

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