Head Trauma And Acute Intracranial Events Flashcards
(22 cards)
What are the two types of primary head trauma?
Focal and diffuse
Focal- haematoma- extradural, subdural, intracerebral. Contusion- coup/ contracoup.
Diffuse- concussion, diffuse axonal injury.
What is a cerebral contusion?
Bruising of brain where blood mixes with cortical tissue due to microhaemorrhages and small vessel leaks.
What is the pathophysiology of a cerebral contusion?
Trauma —> microhaemorrhages—> cerebral contusin—> cerebral oedema—> raised ICP—> coma
What is the difference between a coup and contracoup cerebral contusion?
Coup= damage caused at site of injury
Contra coup= damage caused at opposite side to injury due to bouncing of brain in skull
What is concussion?
Head injury with temporary loss of brain function
What is the pathophysiology of concussion?
Trauma—> stretching and injury to axons—> impaired neurotransmission, loss of ion regulation, reduction in cerebral blood flow= temporary brain dysfunction.
What is post concussion syndrome?
Difficulty in thinking clearly and concentrating
Physical- headache, nausea, vomiting, balance problems
Emotional- irritability, sadness, nervousness
Sleep disturbance sleeping more or less than usual
What is diffuse axonal injury?
Shearing of interface between grey and white matter following traumatic acceleration/ decceleration or rotational injuries to brain. This damages intracerebral axons and dendritic connections
What are the clinical signs of basilar skull fracture?
Raccoon eyes CSF rhinorrhea CSF otorrhea Battle sign Haemotympanum Haematoma.
What are the urgent CT head criteria?
Consciousness- GCS < 13 at any point
GCS < 14 , 2 hours after injury.
Neurological abnormality eg focal neurological deficit, seizure or LOC with age>65, coagulopathy, mechanism of injury, antegrade amnesia
Suspected skull fracture
Discrete episodes of vomiting
What is the management of extra dural haemorrhage?
If small- can be observed and managed conservatively with neurological follow up.
If large- needs craniotomy and clot evacuation.
What are the complications of extra dural haemorrhage?
Permanent brain damage Coma Seizures Weakness Pseudoaneurysm Arteriovenous fistula.
In what situation is acute sub dural haemorrhage most common?
In head trauma.
In what situations is subacute or chronic sub dural haemorrhage common?
In elderly with vague or absent history of head trauma.
How do acute bleeds appear on CT head?
Hyper dense i.e brighter than brain tissue
How do chronic bleeds appear on CT head?
Darker than brain tissue.
Where does blood collect in subarachnoid haemorrhage?
Between arachnoid and pia mater
How do patients with sub arachnoid haemorrhage commonly present?
Sudden onset thunderclap headache
Meningism N+V Fever Focal neurological deficits LOC
What factors can increase the risk of a berry aneursym?
Family history of them
Hypertension
Heavy alcohol consumption
Abnormal connective tissue disorders eg autosomal dominant polycystic kidney disease, ehlors danlos, neurofibromatosis, marfans disease.
Where do berry aneurysms most frequently occur?
At the junction of the anterior cerebral artery and the anterior communicating artery.
What changes in the CSF will be detected in SAH ?
Presence of RBCs
Xanthochromia- RBCs break down to make a yellowy substance.
What management is required for a patient with SAH?
Stabilise the patient
Prevent rebleeding
Treat cerebral vasospasm (can cause ischaemia in rest of brain)
Correct hyponatraemia
Neurosurgical intervention if large bleed.
