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Nervous System > Head injury > Flashcards

Head injury Flashcards

1
Q

What are the clinical aspects of head injury?

A

Non missile vs missile
Focal vs diffuse
Primary vs secondary

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2
Q

What are the types of head injury?

A

Scalp injuries
Skull fractures
Intracranial haemorrhage- EDH, SDH, SAH
Intrinsic brain injury- oedema, contusions, lacerations, herniation
Diffuse traumatic axonal injury

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3
Q

What are the types of scalp injuries?

A

Abrasions
Bruises
Lacerations
Incisions
Burns

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4
Q

What are the types of skull fractures?

A

Linear
Depressed
Comminuted
Ring
Contre-coup
Diastatic

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5
Q

What is linear skull fracture?

A

Commonly temporo-parietal from blow or fall onto side or top of head

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6
Q

What is depressed skull fracture?

A

Focal impact which may push fragments inwards to damage the meninges, blood vessels and brain
Force over small area

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7
Q

What is comminuted skull fracture?

A

Fragmented skull
AKA mosaic fracture
Force over large area

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8
Q

What is ring skull fracture?

A

Fracture line encircling foramen magnum
Skull base and cervical spine forced together

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9
Q

What is contre-coup fracture?

A

A fracture of the cranial vault occurring at a site approximately opposite the point of impact

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10
Q

What is diastatic fracture?

A

Follows suture lines
Children

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11
Q

What is EDH?

A

Extradural haemorrhage
Accumulation of high-pressure arterial blood strips dura off inner surface of skull
Egg shaped haematoma that accumulates over a few hours

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12
Q

What causes the majority of EDHs?

A

Fracture of squamous temporal bone
Causes tear in middle meningeal artery

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13
Q

What is SDH?

A

Subdural haemorrhage
Accumulation of low- pressure venous blood from bridging veins
Crescent shaped haematoma

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14
Q

When does acute SDH become chronic?

A

> 2 weeks
Soft jelly consistency of haematoma is broken down into serous fluid
Membrane of granulation tissue forms

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15
Q

What causes SDHs?

A

Any motion which causes rotational/shearing forces can cause the veins to stretch and tear

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16
Q

What is SAH?

A

Subarachnoid haemorrhage
Rapid collapse and quick death
Associated with cerebral contusions
Sudden onset of worst ever headache

17
Q

What is the most common cause of SAH?

A

Rupture of cerebral artery -> berry aneurysm

18
Q

What is xanthochromia?

A

The yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space

19
Q

What is the management of SAH?

A

Coiling
Surgical clipping
Nimodipine to reduce vasospasm (calcium channel blocker)
Insertion of extra ventricular drains of hydrocephalus occurs

20
Q

Why is surgical clipping not first line intervention?

A

Involves craniotomy is is a more invasive procedure than coiling

21
Q

What are the 2 types of brain contusions?

A

Coup contusions
Contre-coup contusions

22
Q

What are the types of brain herniation?

A

Subfalcine herniations
Central herniation
Transtentorial uncal herniation
Cerebellar tonsillar herniation

23
Q

What is transtentorial uncal herniation?

A

Also known as coning
Transforaminal herniation of brainstem and cerebellar tonsils through foramen magnum

24
Q

What is diffuse traumatic axonal injury?

A

Tearing of axons in white matter
Due to high force rotation acceleration-deceleration injury

25
Q

What areas of the brain are susceptible to diffuse traumatic axonal injury?

A
  • Corpus callosum
  • Para-sagittal white matter
  • Posterior internal capsule
  • Dorsolateral aspects of rostral brainstem
  • Cerebellar peduncles
26
Q

What biochemical changes in the brain can cause injury?

A

Head injury triggers cascade of biochemical changes:
- Glutamate causes massive calcium influx which has a neurotoxic effect
- Nitrous oxide has a neurotoxic effect

27
Q

What pathology is associated with head injury alongside long bone fractures?

A

Fat embolism
Lodges in lungs and cranial blood vessels
Multiple petechial haemorrhages in white matter

28
Q

What is the management of head injury?

A

Stabilise cervical spine
ABC
Intubation and ventilation if GCS<8 (Glasgow coma scale)
Treat raised ICP
Cranial imaging
Neuro observation

29
Q

What is involved in treatment of raised ICP?

A
  • Surgery to relieve pressure
  • Osmotic diuretics e.g. mannitol
  • Reduce pain
  • Maintain good PO2, reduce PCO2
  • Reduce metabolism- reduce temperature, barbiturates
  • Sit up patient
  • Avoid neck compression

Nervous System (18 decks)

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