Head Injuries

Question 1

What is a Primary Head Injury?

Answer 1

Immediate damage

Question 2

What is a Secondary Head Injury?

Answer 2

As a result of hypoxia or reduced perfusion

Question 3

What is a typical minor head injury?

Answer 3

Facial injuries

Highly vascular so bleed a lot
Risk of airway compromise

Question 4

What should you always consider in a patient with a nose bleed?

Answer 4

Septal haematoma

Question 5

Name three types of skull fractures

Answer 5

Linear non displaced
Depressed
Open

Question 6

What is ‘Coup’ and ‘Contra Coup’?

Answer 6

Coup is the initial impact
Contra-coup is the rebound impact

Question 7

Describe three features of concussion

Answer 7

1) No structural damage
2) Neurological symptoms (reduced concentration, nausea, photophobia)
3) No focal neurological symptoms

Question 8

Describe three features of cerebral contusion

Answer 8

1) Structural damage (oedema)
2) Neurological symptoms (exaggerated)
3) Focal neurological symptoms

Question 9

What is it called when concussion symptoms persist beyond 1m

Answer 9

Post Concussion Syndrome

Question 10

What is Chronic Traumatic Encephalopathy?

Answer 10

Constant concussions
Associated with boxing and NFL
Diagnosis of exclusion
End stage is dementia and aggression

Question 11

What is Diffuse Axonal Injury?

Answer 11

Severe blunt head trauma
Brain does not move in one block
Shears white matter

Question 12

How does diffuse axonal injury present?

Answer 12

Global neurological dysfunction
Likely unconscious

Question 13

Give three features of an extradural bleed

Answer 13

1) Likely middle meningeal artery
2) LOC, then lucid period before deterioration
3) Lemon shaped bleed

Question 14

Give five features of a subdural bleed

Answer 14

1) Onset can take days
2) Fluctuating symptoms
3) Typically caused by shearing of bridging veins
4) Alcoholics and elderly vulnerable
5) Crescent shaped bleed

Question 15

Is LOC an indication for head CT?

Answer 15

Not unless other risk factors present

Question 16

Why does head CT reduce sensitivity over time?

Answer 16

Blood haemolyses

Question 17

Name two ways a traumatic tap can be differentiated from SAH

Answer 17

1) Only the first few vials will have blood in traumatic tap
2) Traumatic tap wont be yellow after centrifugation

Question 18

Name three indications for a head CT (adult)

Answer 18

1) Vomiting more than once
2) GCS<15 after 2h
3) Seizure

Question 19

Name three indications for a head CT (child)

Answer 19

1) Vomiting more than three times
2) Suspicion of NAI
3) Any sign of basal skull #