Head Trauma

Question 1

Head Trauma
Common Injuries
Epidural Hematoma (EDH)

Answer 1

Often temporal bone fracture resulting in middle meningeal artery injury
Primarily a disease of the young; rare in elderly or children <2 due to tight attachment of dura to skull
Temporary improvement in
condition with subsequent worsening is highly suggestive

Initial Loss of Consciousness: Patients may initially lose consciousness at the time of impact.

Lucid Interval: A period of apparent alertness may occur before neurological deterioration.

Rapid Deterioration: Symptoms such as headache, nausea, vomiting, seizures, paralysis, and progressive loss of consciousness can develop.

Enlarged Pupil: One pupil may become significantly larger than the other.

Question 2

Head Trauma
Common Injuries
Subdural Hematoma (SDH)

Answer 2

Subdural Hematoma (SDH): most common; disruption of bridging veins; most commonly during acceleration-deceleration injuries
Common in pts with brain
atrophy (elderly, alcohol) as bridging veins transverse greater distances
Slow venous bleeding delays symptoms; 20% present with bilateral SDH

Head injury:
The most common cause is a blow to the head, often from a fall, car accident, or other traumatic event.

Tearing of bridging veins:
Tiny blood vessels (bridging veins) that connect the brain to the skull can tear, causing blood to leak into the subdural space.

Elderly and alcohol use:
Older adults and individuals with heavy alcohol use are at higher risk due to brain shrinkage and potential weakening of the bridging veins.

Medications:
Long-term use of certain medications like blood thinners can increase the risk of subdural hematoma.

Question 3

Head Trauma
EDH on CT scan

Answer 3

Bi-convex, lentiform
Blood pools superior (epi) to dura
Unable to cross suture lines

Question 4

Head Trauma
SDH on CT scan

Answer 4

Crescent shaped
Blood pools between dura and arachnoid and is not limited by suture lines, only by dural reflections (i.e. falx cerebri, tentorium, falx cerebelli)

Question 5

Head Trauma
Management
Concussion

Answer 5

Outpatient management for uncomplicated cases: GCS 15, normal exam and CT head
24 hr period of cognitive rest with gradual return to work/play pending
resolution of symptoms

Question 6

Head Trauma
Management
Epidural and Subdural Hematomas

Answer 6

Consult neurosurgery for management (i.e. burr hole, craniotomy, decompressive craniectomy, middle meningeal artery embolization)

Craniotomy: a craniotomy involves making an opening in the skull to access and remove the hematoma.

Burr holes: small holes can be drilled in the skull to allow for drainage of the hematoma.

Middle meningeal artery embolization:
This procedure is sometimes used to stop bleeding in chronic subdural hematomas.

Reduce ICP: raise head of bead to 30°; IV Mannitol 1g/kg over 20 mins or
HTS 1.25-5mL/kg over 5 mins hyperventilation; diuretics

Medications: Diuretics and corticosteroids can be used to reduce swelling, and anti-seizure medications may be prescribed to prevent seizures.

Reverse anticoagulation (i.e. give prothrombin complex concentrate if on
Warfarin or Xa inhibitors; Praxbind for Dabigatran)