Head Injury

Question 1

CT head within 1 hour

Answer 1

GCS < 13
GCS < 15 @2 hrs post-injury
suspected open/depressed skull fracture
sign of basal skull fracture
post-traumatic seizure
focal neurological deficit
>1 episode of vomiting

Question 2

CT head within 8 hours

Answer 2

> 65 years

• Hx of bleeding or clotting disorders including anticoagulants
• dangerous mechanism of injury (collision/ fall from height)
• > 30 minutes’ retrograde amnesia of events immediately before the head injury

Question 3

Signs of base of skull fracture

Answer 3

haemotympanum
‘panda’ eyes
cerebrospinal rhinorrhoea from ear or nose
Battle’s sign

Question 4

What mechanism causes diffuse axonal injury

Answer 4

deceleration injury

Question 5

Where do contusions usually occur in relation to the injury?

Answer 5

adjacent to (coup) or contralateral (contre-coup) to the side of impact

Question 6

Difference between Primary and Secondary brain injury

Answer 6

Primary
- either focal (contusion/haematoma) or diffuse (diffuse axonal injury)

Secondary
- cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation exacerbates the original injury.

Question 7

What makes up the Cushing’s reflex?

Answer 7

hypertension and bradycardia

• occurs late and is usually a pre terminal event

Question 8

Bleeding between dura mater and the skull. The majority occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery.

Features of raised ICP

some patients may exhibit a lucid interval

Answer 8

Extradural haematoma

Question 9

Bleeding into the outermost meningeal layer. Most common around the frontal and parietal lobes.

Risk factors include old age, alcoholism and anticoagulation.

There may be fluctuating confusion/consciousness

Answer 9

Subdural haematoma

Question 10

Sudden occipital headache.

Usually occurs spontaneously in the context of a ruptured cerebral aneurysm, may also be seen when patient has sustained a traumatic brain injury

Answer 10

Subarachnoid haemorrhage

Question 11

Collection of blood within the substance of the brain.

Patients will present similarly to an ischaemic stroke (which is why it is crucial to obtain a CT in head in all stroke patients prior to thrombolysis) or with a decrease in consciousness.

CT imaging will show a hyperdensity (bright lesion) within the substance of the brain.

Treatment is often conservative under the care of stroke physicians, but large clots in patients with impaired consciousness may warrant surgical evacuation.

Answer 11

Intracerebral haemorrhage

Question 12

Causes/Risk factors for intracerebral haemorrhage

Answer 12

• hypertension
• vascular lesion (e.g. aneurysm or AVM)
• cerebral amyloid angiopathy
• trauma
• brain tumour or infarct
• thrombolysis in stroke