Head Trauma

Question 1

What are the classifications of head injuries?

Answer 1

• Primary
• Secondary

Question 2

What are primary head injuries?

Answer 2

Those that occur immediately after initial trauma

Question 3

What are the types of primary head injuries?

Answer 3

• Focal
• Diffuse

Question 4

What are focal head injuries?

Answer 4

Ones that occur in a specific place

Question 5

What are diffuse head injuries?

Answer 5

Ones that occur throughout the brain

Question 6

What are the types of focal head injuries?

Answer 6

• Haematoma
• Contusion

Question 7

What are the types of haemotomas?

Answer 7

• Extradural
• Subdural
• Intracerebral

Question 8

What can happen if you get a large enough contusion?

Answer 8

Can get intracranial haemorrhages and tears to the cranial nerves

Question 9

Where can contusions occur?

Answer 9

• Site of impact (coup)
• Site opposite impact (contre-coup)

Question 10

What are the types of diffuse head injuries?

Answer 10

• Concussion
• Diffuse axonal injury

Question 11

What are the non-traumatic causes of head injury?

Answer 11

• Anoxia
• Infection
• CVA/TIA
  Tumour
• Metabolic disorder

Question 12

What are the categories of traumatic head injuries?

Answer 12

• Open (penetrating)
• Closed (internal pressure and shearing)

Question 13

What happens in penetrating head injuries?

Answer 13

Something pierces the skull and reaches the dura mater

Question 14

What are the causes of open head injuries?

Answer 14

• Assault
• Fall
• Surgery

Question 15

What are the causes of closed head injuries?

Answer 15

• Assault
• Falls
• Accidents
• Abuse

Question 16

What is a cerebral contusion?

Answer 16

‘Bruising’ of the brain, whereby blood mixes with cortical tissue due to microhaemorrhages and small blood vessel leaks

Question 17

How can a cerebral contusion occur directly under the impact?

Answer 17

If the brain hits a bony ridge

Question 18

What is the most common site of cerebral contusions?

Answer 18

Anterior temporal lobe

Question 19

What can happen over time with cerebral contusions?

Answer 19

Can develop and become complicated, can develop mass effects

Question 20

What symptoms might arise with temporal and frontal lobe contusions?

Answer 20

Get attention, emotional, and memory problems

Question 21

How can cerebral contusions lead to coma?

Answer 21

They can cause cerebral oedema or an intracerebral bleed, leading to raised ICP and therefore a coma

Question 22

How can a cerebral contusion occur on the opposite side to impact?

Answer 22

The energy dissipates and causes brain to hit the opposite side of the skull.

The amount of energy that dissipates determines what contusion you get

Question 23

What is concussion?

Answer 23

Head injury with temporal loss of brain function

Question 24

Describe the pathophysiology of concussion?

Answer 24

Trauma leads to stretching and injury of axons, which leads to impaired neurotransmission, loss of ion regulation, and a reduction in cerebral blood flow, leading go temporary brain dysfunction

Question 25

What do the symptoms of concussion depend on?

Answer 25

The site of injury

Question 26

What symptoms might a frontal lobe concussion cause?

Answer 26

Problems with behaviour and memory

Question 27

What problems might a temporal lobe concussion produce?

Answer 27

Problems with emotion and mood instability

Question 28

What causes symptoms of concussion?

Answer 28

Believed to be a mixture of physical and psychological factors, including structural problems with the brain and neurotransmitter problems

Question 29

What are the categories of symptoms of post-concussion syndrome?

Answer 29

* Thinking/remembering * Physical * Emotional/mood * Sleep disturbances

Question 30

What are the thinking/remembering symptoms of post-concussion syndrome?

Answer 30

* Difficulty thinking clearly * Feeling slowed down * Difficulty concentrating * Difficulty remembering new information

Question 31

What are the physical symptoms of post-concussion syndrome?

Answer 31

* Headache * Nausea or vomiting * Balance problems * Dizziness * Fuzzy or blurry vision * Feeling tired, having no energy * Sensitivity to noise or light

Question 32

What are the emotional/mood symptoms of post-concussion syndrome?

Answer 32

* Irritability * Sadness * More emotinal * Nervousness or anxiety

Question 33

What are the potential sleep disturbances in post concussion syndromes?

Answer 33

* Sleeping more than usual * Sleeping less than usual * Trouble falling asleep

Question 34

What is diffuse axonal injury?

Answer 34

Shearing of interface between grey and white matter following traumatic acceleration/deceleration, or rotational injuries to the brain damaging the intra-cerebral axons and dendritic connections

Question 35

How can diffuse axonal injury cause coma?

Answer 35

Shearing of the grey and white matter interface can cause axonal death, which can cause cerebral oedema, leading to raised ICP then coma

Question 36

What is a basilar skull fracture?

Answer 36

A bony fracture within the base of the skull

Question 37

What bones form the base of the skull?

Answer 37

* Temporal * Occipital * Sphenoid * Ethmoid

Question 38

What needs to be considered when mananging basilar skull fractures?

Answer 38

A patient is not going to have an isolated basal skull fractures, they will also have other problems as it requires so much force

Question 39

What does a basilar skull fracture cause?

Answer 39

Tears in the meninges, leading to CSF leakage

Question 40

What are the clinical signs of basilar skull fractures?

Answer 40

* Raccoon eyes * CSF rhinorrhoea * CSF otorrhoea * Battle sign * Haemotympanum * Bump

Question 41

How are basilar skull fractures managed?

Answer 41

* Traumatic brain injury management, *including ICP control* * Seek and treat complications * Elevation of depressed skull fractures * *If there is persistent CSF leakage,* surgery

Question 42

What GCS indicates a mild head injury?

Answer 42

13-15

Question 43

How long does post-traumatic amnesia last with mild head injury?

Answer 43

\<1 day

Question 44

How long does loss of consciousness last with mild head injury?

Answer 44

0-30 minutes

Question 45

What GCS indicates a moderate head injury?

Answer 45

9-12

Question 46

How long does post-traumatic amnesia last with moderate head injury?

Answer 46

\>1 to \<7 days

Question 47

How long does loss of consciousness last with moderate head injury?

Answer 47

\>30 min to \<24 hours

Question 48

What GCS indicates a severe head injury?

Answer 48

3-8

Question 49

How long does post-traumatic amnesia last with severe head injury?

Answer 49

\>7 days

Question 50

How long does loss of consciousness last with severe head injury?

Answer 50

\>24 hours

Question 51

What is considered when determining if a patient needs an urgent head CT?

Answer 51

* Consciousness * Neurological abnormality * Suspected open/depressed skull fracture, or signs of a basal skull fracture * 2+ discrete episodes of vomiting

Question 52

What are the consciousness criteria for urgent head CT following injury?

Answer 52

* GCS \<13 at any point * GCS \<14 more than 2 hours after injury

Question 53

What neurological abnormalities indicate the need for an urgent head CT?

Answer 53

* Focal neurological deficit * Seizure * Loss of consiousness with any of; * Age \>65 * Coagulopathy * Dangerous mechanism of injury * Antegrade amnesia \>30 minutes