Fast Limited Good - bones + FBs Cheap

Virtually no information about soft tissues Must be done in multiple planes almost no acute management = Head trauma

Fast few contraindications (Preg, peds = but high Radio) all 3 planes Good = bones, blood, FBs

VERY HIGH radiation Bad = soft tissue (MRI better)

good - soft tissue/ligaments, brain/spinal no radiation

Inspect cranium Cranio-cervical junction Seizure Alertness CN exam Motor exam Sensory exam Reflexes

Brain Trauma Flashcards by O lawformonde

X rays

Pros

Fast
Limited
Good - bones + FBs
Cheap

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X rays

Cons

Virtually no information about soft tissues
Must be done in multiple planes
almost no acute management = Head trauma

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CTs

Pros

Fast
few contraindications (Preg, peds = but high Radio)
all 3 planes
Good = bones, blood, FBs

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CTs

Cons

VERY HIGH radiation

* Bad = soft tissue (MRI better)

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MRI

Pros

good - soft tissue/ligaments, brain/spinal

* no radiation

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MRI

Cons

Slow, expensive
Contraindications (stent)
*Low use in acute ettign

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Traumatic Brain Injury

Death risks

Older = Falls
Self-harm = middle age
MVC = young
Assault = infant

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Injury w/

consciousness loss
memory loss - events preceding accident
mental status altering
focal neuro s/s

Mild TBI

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= Mild TBI

transient LOC
lightheadedness
n/V
vision
cognitive/ memory

Concussion

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TBI

Initial management

triage
+/- trauma team
Image (CT w/o contrast)
Labs: CBC, BMP, Coags (PT etc.), UA/Utox
Neurosurgical consult

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Initial Neuro exam

Inspect cranium
Cranio-cervical junction
Seizure
Alertness
CN exam
Motor exam
Sensory exam
Reflexes

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Assess consciousness?

Glasgow Coma Scale

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Assess concussion?

Possible eval tool = ACE (acute concussion evaluation) , MANY OTHERS POSSIBLE

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Concussion management

*REST
*return to play once symptoms have resolved
(7-14 days, possibly weeks to months)
-FOLLOW LOCAL TOOL for stepwise play activity assessment (must complete step w/o symptoms for 24 hours) = VERY LETIGIOUS

*Managing these S/S = REFER TO NEURO

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Concussion lasting 3 months + ?

Post-concussive syndrome

Refer to neuro
Delayed hydrocephalus? Post traumatic seizures?

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S/s w/

Severe headache
Vomiting
Age >60
Intoxication
Amnesia
Post-traumatic seizure
Blood thinners
PE - trauma above clavicle

????

RED FLAG - SCAN NOW
Activate Trauma team

(Especially - Intoxication + bruise + confusion)

CT rules out

Blood
Hydrocephalus
Cerebral swelling
Skull fracture
Pneumocephalus
Midline shift

acute/subacute/trauma
distant trauma Hx
size, midline shift, GCS, location

SAH
*size, midline shift, GCS, location

*ANY SIGN? = REFER TO NEURO OR

CT findings

Acute blood =WHITE
crescent shaped/ concave
+/- Mass Effect
+/- Midline shift

Subdural Hematoma

*Head injury w/ brief traumatic LOC–> Lucid Interval–> Deterioration –>Coma

Epidural Hematoma

Less common than Subdurals
Middle meningial arterial bleeding

Acute blood white
Biconvex shape (egg) next to skull

Epidural Hematoma

Subdural vs. Epidural Hematoma

Subdural = crescent shape

Epidural = balloon shape

Epidural hematoma

Management

surgery

* can herniate quickly!

5 forms of herniation

Central (transtentorial)
Uncal

Cingulate/subfalcine
Upward cerebellar
Tonsillar

* altered mental status * respiration, oculomotor motor problems Diencephalon through tentorial incisura Shear pituitary stalk - DK

Central Herniation *trapped PCA's/pca strokes = cortical blindness

* Dilated Pupil * contralateral weakness * rapid expanding traumatic hematomas = push uncus + hipoccampus OVER tentorium

Uncal Herniation * 3rd nerve * Midbrain compression - contra weakness

* gunshot wounds - most lethal | * soft tissue/skull factors

Penetrating trauma *bacteria dragged in

Craniectomy vs Craniotomy

- otomy = skull bone put back | - ectomy = no bone put back

Penetrating trauma workup Image

Cerebral angiogram

* bleeding into Subarachnoid layer * usually small vessels * severe TBI s/s

SubArach Hemorrhage - Trauma * seizure prophylaxis * not operable

Intracerebral hemorrhage/ Cerebral contusion

* Trauma * w/ tSAH * have to do mutliple CTs to see * not operative

CTs = how often

Every 6 hours

*decline in memory/executive function *Mood/behavior change *eventual dementia AFTER REPEATED TRAUMA

Chronic Traumatic Encephalopathy * DX ONLY post-mortem * s/s usually decades after trauma (40-50 y/o)

Danger!!!! Head trauma w/

*BLOOD THINNER (Aspirin, Coumadin, Eliquis, Pradaxa) * Intoxicated (DRUNK) * unexplainable abnormal exam finding

"He's just drunk"

* Liver disease --> clotting factors | * S/s drunk SAME as TBI