𝑻𝒓𝒂𝒖𝒎𝒂𝒕𝒊𝒄 𝑩𝒓𝒂𝒊𝒏 𝑰𝒏𝒋𝒖𝒓𝒚

Question 1

What is the definition of Traumatic Brain Injury?

Answer 1

A non-degenerative non-congenital insult to the brain from external mechanical force leading to permanent or temporary impairment of cognitive physical & psychological functions

Question 2

What are the three most common causes of TBI according to the epidemiology?

Answer 2

Falls
Road traffic accidents
Assaults

Question 3

What is the difference between Coup and Contrecoup injury?

Answer 3

Coup occurs under site of impact while Contrecoup occurs on opposite side of impact

Question 4

What is the Monroe-Kellie doctrine?

Answer 4

The sum of volumes of brain, CSF & intracranial blood is constant

V(cranium) = V(brain) + V(CSF) + V(blood)

Question 5

What is the formula for Cerebral Perfusion Pressure (CPP)?

Answer 5

CPP = MAP - ICP (Mean Arterial Pressure minus Intracranial Pressure)

Question 6

What are the three indices of TBI severity?

Answer 6

Mild Moderate & Severe

Question 7

What is primary injury in TBI?

Answer 7

Injury that occurs at the moment of initial trauma

Question 8

What is secondary injury in TBI?

Answer 8

Injury that occurs as indirect result of initial trauma developing over time

Question 9

Name three causes of primary injuries in TBI

Answer 9

Skull lacerations
Skull fractures
Contusions
Diffuse Axonal injury
Intracranial hemorrhage

Question 10

What is the significance of CSF rhinorrhea?

Answer 10

It indicates anterior skull base fracture with CSF leakage

Question 11

What are the three classifications of TBI spectrum (skull)?

Answer 11

Linear (displaced/undisplaced) Ping pong and Depressed (open/closed)

Question 12

What is an extradural hematoma?

Answer 12

A surgical emergency with bleeding between skull and dura

Question 13

Name three sources of extradural bleeding

Answer 13

Middle meningeal artery
Diploe of bone
Dural sinuses

Question 14

What are the classifications of subdural hematoma?

Answer 14

Acute (0-3 days)

Subacute (4-21 days)

Chronic (>21 days)

Question 15

What appears hyperdense on CT in subdural hematoma?

Answer 15

Fresh blood appears hyperdense in first 3 days. It is Acute

Question 16

What is the source of bleeding in subdural hematoma?

Answer 16

Bleeding occurs via bridging veins

Question 17

What is the classic CT appearance of contusions?

Answer 17

Salt & pepper appearance

Question 18

What are four clinical presentations of subarachnoid hemorrhage?

Answer 18

Headache (worst headache of their life)
Loss of consciousness
Photophobia
Nausea/vomiting
Seizures

Question 19

What is the treatment for acute epidural hematoma?

Answer 19

Craniotomy & hematoma evacuation

Question 20

What is the best investigation for diffuse axonal injury?

Answer 20

Difficult to diagnose on CT requiring MRI

Question 21

Name 5 secondary injuries in TBI

Answer 21

Dyselectrolytemia
Hypoglycemia
Hypertension
Seizures
Raised ICP

Question 22

How does cerebral perfusion pressure relate to blood pressure?

Answer 22

CPP = SBP + 2DBP
————— — ICP
3

Question 23

What are Battle’s sign and Raccoon eyes?

Answer 23

Signs of base of skull fracture (periorbital ecchymosis and post-auricular ecchymosis)

Question 24

What is the lucid interval?

Answer 24

Period of consciousness between impact and deterioration in EDH

Question 25

What appears isodense on CT in subacute subdural hematoma?

Answer 25

Blood appears isodense between 4-21 days

Question 26

What grade of diffuse axonal injury affects the brainstem?

Answer 26

Grade 3 (severe) reaching brainstem with high risk of coma

Question 27

Name three clinical presentations of extradural hematoma

Answer 27

Lucid interval Rhinorrhea Severe headache

Question 28

What determines surgical indications for depressed skull fracture?

Answer 28

Openly depressed significantly depressed or fracture through air sinus

Question 29

What appears hypodense on CT in chronic subdural hematoma?

Answer 29

Old blood appears dark due to clot breakdown after 21 days

Question 30

What is the classic shape of a CT finding in epidural hematoma?

Answer 30

Biconvex (lentiform) shape

Question 31

Name four common clinical presentations of TBI

Answer 31

Headache Confusion Slurred speech Vision changes

Question 32

State the monroe-kellie principle

Answer 32

V(cranium) = V(brain) + V(CSF) + V(blood)

Question 33

What grade of diffuse axonal injury affects white matter?

Answer 33

Grade 1 (mild) small injuries in white matter

Question 34

What grade of DAI affects corpus callosum?

Answer 34

Grade 2 (moderate) damage extends to corpus callosum

Question 35

What is the crescent shape on CT indicative of?

Answer 35

Subdural hematoma typically appears crescent-shaped

Question 36

Name three clinical signs of increased ICP

Answer 36

Headache vomiting and altered consciousness

Question 37

What imaging is recommended for suspected diffuse axonal injury?

Answer 37

MRI is recommended as CT may miss the injury

Question 38

What causes the salt & pepper appearance in contusions?

Answer 38

Mixed areas of hyperdensity & hypodensity on CT

Question 39

What are the five clinical presentations of intraventricular hemorrhage?

Answer 39

Altered consciousness Bleeding from craniofacial orifices Seizures Amnesia Vomiting

Question 40

What does the B's in care of unconscious patients stand for?

Answer 40

Brain Breathing Blood Bladder Bowel Body temperature

Question 41

List the components of ATLS protocol examination for TBI

Answer 41

Glasgow Coma Scale Pupils (contraction/fixed) Head (nostrils/external auditory meatus/eyes/globe) Check other injuries (chest/spine)

Question 42

What investigations are required in TBI management?

Answer 42

CT brain (non-contrast) C-spine imaging (X-ray/CT scan) Trauma series Blood work Nexus criteria

Question 43

What are the key steps in preventing secondary injuries?

Answer 43

ICP management Normoglycemia Prevent seizures/hyperthermia/electrolyte derangement Free neck (avoid venous compression) Analgesia

Question 44

What are the cranial complications of TBI?

Answer 44

Post-traumatic seizures Post-traumatic hydrocephalus Post-traumatic depression Persistent focal deficits Cognitive deficits

Question 45

What are the extracranial complications of TBI?

Answer 45

Endocrine— (SIADH/CSW-cerebral salt wasting/hypopituitarism) Respiratory— (pneumonia/atelectasis/aspiration) CVS— (DVT)

Question 46

Name three behavioral/cognitive complications of TBI

Answer 46

Cognitive deficits, behavioral changes, communication deficits

Question 47

What is included in the principle of TBI management?

Answer 47

ATLS, all the activities stated in examination, care of the unconscious

Question 48

What are the main preventive measures for TBI?

Answer 48

Enforce road traffic laws, advocacy & campaigns, protect vulnerable groups, sports safety, occupational/road user safety

Question 49

How should coma be managed in TBI?

Answer 49

Intubate & sedate

Question 50

What is the importance of nurse 30° in TBI management?

Answer 50

To prevent increased intracranial pressure

Question 51

What respiratory complications can occur after TBI?

Answer 51

Pneumonia, atelectasis, aspiration pneumonitis

Question 52

What endocrine complications can occur after TBI?

Answer 52

SIADH, CSW, hypopituitarism

Question 53

What is the significance of checking external auditory meatus in head examination?

Answer 53

To check for CSF otorrhea or bleeding indicating base of skull fracture

Question 54

What are the CT findings of sub-arachnoid hematoma?

Answer 54

The subarachnoid space is Hyperdense

Question 55

What are the classical CT findings of intra-cranial/intra-parenchymal haemorrhage

Answer 55

Hyperdense collection of blood with hypodense oedema Irregular shape Contusions have a salt & pepper appearance

Question 56

What is the treatment of intra-ventricular haemorrhage?

Answer 56

Treatment of the underlying cause (aneurysm, hypertension)

Question 57

What is the treatment of Subdural Haematoma?

Answer 57

Acute— Craniotomy Sub-acute— Burr hole surgery

Question 58

Classify TBI

Answer 58

Indices of severity— mild, moderate & severe Mechanism of injury— Contact/impact, Non-contact/inertial, Blast Pathoanatomic type Reference to suture lines— Caput succedaneum, Subgaleal haemorrhage, Cephalohematoma Presentation—- Adult, child, neonate/infant