Head Injury

Question 1

What are the types of head injury?

Answer 1

Primary vs secondary

Traumatic vs non-traumatic

Mild vs moderate vs severe

Question 2

What is primary head injury?

Answer 2

Head injury occurring immediately after head trauma

Question 3

What is secondary head injury?

Answer 3

Head injury occurring a while after the head trauma

Question 4

What are the types of primary head injury?

Answer 4

Focal

Diffuse

Question 5

What are the types of primary focal head injury?

Answer 5

Haematoma

Contusion

Question 6

What are the types of a primary focal haematoma?

Answer 6

Extradural

Subdural

Intracerebral

Question 7

What are the types of a primary focal contusion?

Answer 7

Coup contusion

Contre-coup contusion

Question 8

What are the types of a primary diffuse head injury?

Answer 8

Concussion

Diffuse axonal injury

Question 9

What are the types of traumatic head injury?

Answer 9

Open

Closed

Question 10

What is an open traumatic head injury?

Answer 10

Something piercing the skull and dura, exposing the brain

Question 11

What is a closed traumatic head injury?

Answer 11

The brain is not exposed

Question 12

What are the causes of traumatic head injury?

Answer 12

Falls

Accidents

Abuse

Surgery

Question 13

What are the types of non-traumatic head injury?

Answer 13

Infection

Stroke or TIA

Tumour

Metabolic disorder

Question 14

What is a cerebral contusion?

Answer 14

Refers to head trauma causing brain to hit bony prominences in the skull or folds of dura

Question 15

What does a contusion result in?

Answer 15

Micro-haemorrhages in the brain

Cerebral oedema, raised intracranial pressure, coma

Question 16

What is a coup contusion?

Answer 16

Injury to brain at the site of impact

Question 17

What is a contre-coup contusion?

Answer 17

Injury to brain on opposite side of impact, due to brain being physically shaken in the skull

Question 18

What is a concussion?

Answer 18

Refers to head trauma causing stretching and injury of axons

Question 19

What does a concussion result in?

Answer 19

Impaired neurotransmission
Loss of ion regulation
Reduction in cerebral blood flow

-all lead to temporary brain dysfunction

Question 20

What is post-concussion syndrome?

Answer 20

Group of symptoms and signs due to the previous damage to the brain

Question 21

What are some signs and symptoms of post-concussion syndrome?

Answer 21

Headache

Sensitivity to light or noise

Dizziness

Sleep disturbance

Difficulty concentrating

Difficulty remembering new information

Question 22

What is diffuse axonal injury?

Answer 22

Shearing of interface between grey and white matter

Question 23

What types of head trauma cause diffuse axonal injury?

Answer 23

Acceleration, deceleration or rotational injuries to the head

Question 24

What is a complication of diffuse axonal injury?

Answer 24

Axonal death, cerebral oedema, raised intracranial pressure and then a coma

Question 25

What is a basilar skull fracture?

Answer 25

Bony fracture in the base of the skull

Question 26

What are the signs and symptoms of a basilar skull fracture?

Answer 26

Raccoon eyes CSF otorrhea, meaning CSF leaks into middle ear CSF rhinorrhea, CSF leaks from the nose Battle sign

Question 27

How does CSF leak out through the nose?

Answer 27

CSF leaks from middle ear through Eustachian tube into nasopharynx

Question 28

Why does a basilar skull fracture give bruising?

Answer 28

Tears of dura and blood vessels

Question 29

Why does a basilar skull fracture give CSF leakage?

Answer 29

Tears in meninges

Question 30

How is a basilar skull fracture treated?

Answer 30

Elevation of depressed skull fractures Control intracranial pressure Persistent CSF leaks treated by surgery Seek out and treat complications, likely to have other injuries due to amount of force required to break base of skull

Question 31

What are the features of a mild head injury in terms of - GCS score - duration of post traumatic amnesia - duration of loss of consciousness?

Answer 31

GCS score 13-15 Post-traumatic amnesia lasts less than 1 day Loss of consciousness lasts less than half an hour

Question 32

What are the features of a moderate head injury in terms of - GCS score - duration of post-traumatic amnesia - duration of loss of consciousness

Answer 32

GCS score 9-12 Post-traumatic amnesia lasts less than a week Loss of consciousness lasts less than 24 hours

Question 33

What are the features of a severe head injury in terms of - GCS score - duration of post-traumatic amnesia - duration of loss of consciousness

Answer 33

GCS score 3-8 Post-traumatic amnesia lasts more than a week Loss of consciousness lasts more than 24 hours

Question 34

What are the criteria for an urgent head CT scan?

Answer 34

GCS score less than 13 whenever GCS score less than 14, two hours after head injury ``` Depressed skull fracture Focal neurological deficit Seizure when don’t usually have them Two or more episodes of vomiting Loss of consciousness and are above 65 or have coagulopathy or dangerous mechanism of injury, antegrade amnesia more than 30 minutes ```

Question 35

What is antegrade amnesia?

Answer 35

Loss of memory of what has just occurred

Question 36

Why is loss of consciousness and being above 65 an indication for urgent head CT scan?

Answer 36

Subdural haematoma more likely | Due to brain shrinking with age, increased tension on bridging veins, more likely to rupture

Question 37

Why is loss of consciousness and coagulopathy an indication for an urgent CT head scan?

Answer 37

Taking warfarin and heparin gives increased risk of bleeding