33. Head Injuries

Question 1

In what cases should a head injury be transferred to hospital?

Answer 1

Unequal pupils
Unequal motor examination
Open/exposed brain
CSF leaking
Neuro deterioration
Depressed skull fracture

Question 2

What management should be done to a patient with a head injury before reaching hospital?

Answer 2

Prevent hypoxia and hypotension

Question 3

How is a patient with a head injury assessed once they get to hospital?

Answer 3

Glasgow coma scale
Pulse and BP
Pupils and focal neuro deficits

Question 4

What type of injury would cause a linear skull fracture?

Answer 4

Simple fall

Question 5

What kind of fracture would result from a depressed skull fracture?

Answer 5

Focused, direct blow

Question 6

What kind of accident would cause a basilar skull fracture?

Answer 6

Fall from height or RTA

Question 7

What group of people can have ping-pong fractures?

Answer 7

Neonates

Question 8

What is a diastatic skull fracture?

Answer 8

Along suture lines

Question 9

What complications might arise from a skull fracture?

Answer 9

CSF leakage
Infection
Extradural haemorrhage
Black eyes

Question 10

What bone and artery are most often damage in an extra-dural haemorrhage?

Answer 10

Petrous temporal bone

Question 11

What does the lucid interval describe?

Answer 11

A person with an extradural haemorrhage will be conscious for a period of time, and collpase a few hours later

Question 12

What blood vessels are sub-dural haemorrhages usually caused by?

Answer 12

Bridging vein, venous sinus

Question 13

What groups of people are sub-dural haemorrhages most common in?

Answer 13

Elderly
Alcholics
‘Shaken baby’
Whiplash

Question 14

What is a significant sub-arachnoid haemorrhage usually caused by?

Answer 14

Severe trauma
Damage to the neck
Rupture of aneurysm

Question 15

What does a basal sub arachnoid haemorrhage with no existing pathology suggest?

Answer 15

Blunt impact which tore the vertebral artery

Question 16

What are the primary forms of brain injury?

Answer 16

Cortical contusions and lacerations

Diffuse axonal or vascular injury

Question 17

What are the early secondary causes of brain injury?

Answer 17

Hypoxia
Ischaemia
Swelling
Intracranial haematoma

Question 18

What are the late secondary causes of brain injury?

Answer 18

Epilepsy

Infection

Question 19

What is the difference between a coup or contra-coup injury?

Answer 19

Coup is at side of blow: contusions with no fracture

Contra-coup is at opposite side of blow

Question 20

What causes diffuse axonal or vascular injury?

Answer 20

Acceleration/deceleration and rotational forces

Question 21

What is a gliding contusion?

Answer 21

Brain rubs against a projecting surface

Causes haemorrhage of corpus collosum and brain stem

Question 22

Which cranial nerve is the first one stretched in high intracranial pressure?

Answer 22

3

Question 23

What are the symptoms of raised intracranial pressure?

Answer 23

Headache
Vomiting
Papilloedema

Question 24

What effect does alcohol have on head injuries?

Answer 24

Causes an increase in muscle laxity which can increase the force of a rotational injury
Longer period of post-injury apnoea

Question 25

What types of injury can lead to post traumatic epilepsy?

Answer 25

Contusions, depressed fractures

Question 26

What types of injury can lead to post traumatic encephalopathy?

Answer 26

Repeated small injuries eg. sports related

Question 27

What effect can blows to the neck have?

Answer 27

Vagal inhibition
Fracture larynx
Subarachnoid haemorrhage

Question 28

What might happen if a patient sustains. a stab wound to the neck?

Answer 28

Bleeding into airways and possibility of air embolism