Week 6: Trauma and Increased intracranial pressure, and Headache Flashcards Preview

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Flashcards in Week 6: Trauma and Increased intracranial pressure, and Headache Deck (30)
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Define concussion.

Altered consciousness as a result of closed head injury (transient disturbance in neuronal function)
-no gross or microscopic parenchymal abnormalities
-no CT or MRI findings


Define contusion

A bruise of the brain where sudden head deceleration causes the brain to impact on bony prominences (temporal, frontal, occipital)


What are characteristics of a linear skull fracture.

-substantial force
-relation to suture line
-relation to vascular structure


What is a comminuted skull fracture?

-multiple fragments


What is an open or compound fracture?

-fracture underlying a scalp laceration, predisposes to infection


What is a depressed skull fracture?

-fragments indented greater than width of inner and outer tables. laceration of underlying dura or brain my result in seizure, focus, or focal neurologic deficits, and infection


What is the exception or contraindication for surgery in a depressed skull fracture?

If depressed fracture is overlying and depressing a dural sinus, may be dangerous to elevate


What is the Monroe-Kellie Doctrine?

Sum of the intracranial volumes of BLOOD, BRAIN, and CSF is other components is constant. Increase in any one of these is offset by a decrease in another
-since volumes are contained in rigid container


What is normal cerebral perfusion pressure? How is CPP calculated? What is normal intracranial pressure?

-normal is >50mm Hg
-CPP=mean arterial pressure-intracranial pressure
-normal ICP>20 mm Hg in adults


What are the characteristics of epidural hematomas?

-between dura and skull
-lens shaped
-restricted by sutures where dura are tightly adhered
-arterial bleeding
-bleeding from middle meningeal artery


What are the characteristics of subdural hematomas?

-between dura and arachnoid
-crescent shaped
-venous bleeding
-bridging veins


What are the characteristics of intracerebral bleeds?

-in parenchyma
-delayed from contusion
-generally more focal deficits than extra cerebral hematomas


What is Cushing's Triad? (signs of increased intracranial pressure)

1. Hypertension
2. bradycardia
3. respiratory irregularity


What are the characteristics of a tentorial herniation? (uncal)

-lateralized mass
-unilateral compression of brainstem
-compressed 3rd nerve
-compressed cerebral penduncle


What are treatments for increased intracranial pressure?

1. hyperventilation: removes CO2, makes body believe has more oxygen, causes constriction of the vessels
2. mannitol (pharmacological)
3. Catheter to remove CSF fluid
4. barbiturates for vasoconstriction
5. hemicraniectomy
6. ventriculostomy


what are indications for ICP monitoring based on the Glascow Coma Scale?

-GCS3-8 severe head injury: if abnormal CT scan, Age > 40 or BP < 90mmHg or abnormal motor posturing
-GCS 9-12 moderate head injury: if abnormal CT


How is the Glascow Coma Scale calculated?

-Eye opening spontaneously 4, to voice 3, to pain 2, not 1.
-Motor response to command 6, localizes 5, withdraws 4,
Abnormal flexion 3, abnormal extension 2, not 1.
-Verbalizes normally 5, confused 4, abnormal words 3,
Abnormal sounds 2, not 1.
-Score of 15 means minimal head injury severity


List the types of primary headaches.

1. migraine
2. cluster
3. tension
4. other syndromes


What is the workup for a first or worst headache?

-CT head scan
-lumbar puncture: look for xanthochromia (bilirubin making CSF yellow due to blood breakdown in CSF)


What are the red flags in someone who presents with a headache?

-Systemic symptoms: fever, weight loss or secondary risk, e.g. HIV, malignancy
-Neurologic signs: confusion, seizures
-Onset: sudden
-Older: >50 years old
-Previous headache history: first or different, change in frequency, severity, or clinical features


What are findings in the physical exam of an individual with a first or worst headache?

-systemic signs-->secondary headache
-stiff neck
-fundus: papilledema, venous pulsation, retinal hemorrhage
-trigger points


What is the IHS classification for secondary headaches?

1. head trauma
2. vascular disorders, e.g. venous sinus thrombosis
3. non vascular disorders, e.g. hydrocephalus
4. substance use
5. non cephalic infections
6. metabolic syndromes
7. cranium, neck, ear, eye disorders
8. cranial neuralgias
9. psych disorders


What is the IHS criteria for migraine?

-5 or more episodic headaches lasting 4-72 hours with
1. any 2 of the following:
-worsened by movement
-moderate or severe
2. any 1 of:
-nausea or vomiting
-photophobia or phonophobia


What is the criteria for a migraine with aura?

-2 or more attacks
Any 3 of:
-fully reversible
-evolves over 4 minutes
-lasts less than 60 mins
-headache onset within 1 hour


What is the pathogenesis for migraine headaches?

-brainstem has pontine generator for headaches that trigger CN V (trigeminal) -->vessel dilation and constriction as a consequence
-this is what is believed to happen
-therapies target the vascular changes


When should an acute migraine attack be treated?

-treat mild pain
-within 15 minutes of onset of pain
-prior to development of cutaneous allodynia (pain due to things that normally don't cause pain)
-cutaneous allogynia indicates central sensitization


What are the indications for prophylaxis for migraines?

-2+ migraine attacks per month
-single attacks lasting >24 hrs
-major disruptions in life style
-complicated migraine
-failed or overuse of abortive therapy


Describe cluster headaches.

-mainly males affected
-onset 20-40 years old
-unique time pattern
-severe, excruciating
-red eye, nasal signs
-ipsilateral sweating
-lasts 15-80 mins
-ppte. by alcohol or vasodilators
-restless patient


What is the treatment for cluster headaches?

-100% oxygen for 15-30 mins


What is a analgesic rebound headache?

-use of more than 10-15 pills of common NSAIDS per week
-headache due to medicine overuse and body adapting to medicine

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