Head Injury (1)

Question 1

What are its early complications?

What are its late complications?

What are the indicators of a bad prognosis?

Answer 1

➊ Extradural/Subdural haemorrhage, Seizures

➋ Subdural haemorrhage, Seizures, Diabetes Insipidus (Central), Parkinsonism, Dementia

➌ • Elderly
• Decerebrate/Decorticate posturing (Sign of severe brain damage), Extensor spasms, Prolonged coma
‣ Decorticate posturing - lesion above midbrain
‣ Decerebrate posturing - lesion below midbrain

Question 2

What should be assessed initially?

What should be examined?

What do the pupils indicate?

When should a CT Head be done within 1 hr?

Answer 2

➊ GCS, C-spine injury, Focal neurological deficit

➋ GCS, Pupil size + reactivity to light, Signs of head trauma, Signs of Basal Skull Fracture (e.g. CSF ottorhoea/rhinorrhoea, periorbital ecchymosis i.e. raccoon eyes), Neuro exam

➌ Raised ICP if unequal and unreactive to light

➍ • Clinical evidence of skull fracture
• 30+ mins of retrograde amnesia
• Focal neurological deficit or seizure
• GCS < 13 at any time (or < 15 2 hours post-injury)
• 1+ vomiting episode
• LOC and amnesia in pts who:
‣ Are 65+ yrs
‣ Suffered a dangerous mechanism of injury
‣ Have evidence of coagulopathy (including anticoagulation)