Week 8 - Trauma & Head Injuries

Question 1

head injuries can be…

Answer 1

1. mild and have no permanent effects

2. life-threatening & cause massive brain damage & icnreased ICP

Question 2

what are 3 types of head injuries

Answer 2

1. concussion
2. contrecoup
3. contusion

Question 3

what is a concussion

Answer 3

• a reversible interference in brain function resulting from a blow to the head

Question 4

what are symptoms of a concussion (4)

Answer 4

• loss of conciousness
• disruption of neural function
• headache
• retrograde amnesia of events immeditaly following the blow

Question 5

does permanent damage occur with one concussion

Answer 5

• no, typically brain imaging cannot detect permanent damage

Question 6

what does multiple concussions cause

Answer 6

• act synergistically to produce permanent neurological impairment

Question 7

describe symptoms following a consussion

Answer 7

• pts can have post-concussion symptoms that last 4-6 weeks

- ex. headache & insomnia

Question 8

what is a contrecoup head injury

Answer 8

• a rebound injury
• when a blow causes the skull & brain to move backwards & the momentum causes the brain to hit the opposite side of the skull

Question 9

provide an example of a contrecoup head injury

Answer 9

• a boxer gets punched in front of the head
• this causes the face to get blown back, and the brain to bounce off the back of the head

direct injury = front of head
contre coup = back of head

Question 10

what is a contusion

Answer 10

• bruising of the brain tissue resulting from rupture of small blood vessels

Question 11

what can a contusion cause

Answer 11

• depending on the severity of the blow, it can cause increased ICP

Question 12

what are 4 types of skull fractures

Answer 12

• simple
• compound
• depressed
• basilar

Question 13

what is a simple fracture of the skull

Answer 13

• break in the continuity of the bone

- but the wound (skin) remains closed

Question 14

what is a compound fracture of the skull

Answer 14

• break in the continuity of the bone & the skin

- an open fracture where the brain tissue is exposed to the enviro

Question 15

what is a risk of compound fracture

Answer 15

• risk of infection

Question 16

what is a depressed fracture

Answer 16

• when a piece of bone is displaced below the level of the skull & compresses the brain

Question 17

what causes a depressed fracture

Answer 17

• often something heavy falling on the head

Question 18

what is a basilar fracture

Answer 18

• fracture that occurs at the base of the skull

Question 19

what does a basilar fracture often involve?

Answer 19

• the ethmoid bone, specifically the ethmoid cirbriform plate

Question 20

where is the cribriform plate found

Answer 20

• roof of the nasal cavity & is very fragile

Question 21

what are signs of a basilar skull fracture

Answer 21

• leaking CSF thru the ear = otorrhea

- leaking CSF thru the nose = rhinorrhea

Question 22

what are risks associated with basilar fractures

Answer 22

• risk of infection

- laceration of blood vessels or nerves due to sharp edges of the bone

Question 23

why is there increased risk of infection w basilar fracture

Answer 23

• the nasal cavity contains lots of bacteria, and now that the ethmoid bone has broken, this bacteria has access to the brain

Question 24

what are 2 categories of brain damage

Answer 24

1. primary

2. secondary

Question 25

what is primary brain damage

Answer 25

- direct injuries to the brain that occur immediately due to the impact

Question 26

what are examples of primary brain damage (6)

Answer 26

- concussion - contusion - laceration - hemorrhage - hypoxia - diffuse axonal lesion (shearing lesions)

Question 27

what is secondary brain damage

Answer 27

- damage that results from subsequent: - brain swelling - intracranial hematomas - infection - ischemia - hypoxia

Question 28

what is an intracranial hematoma

Answer 28

- collection of blood in a tissue that results from ruptured blood vessels

Question 29

when can intracranial hematomas occur

Answer 29

- immeditaley following an injury | - after some delay

Question 30

what are 3 types of intracranial hematomas

Answer 30

1. epidural 2. subdural 3. intracerebral

Question 31

what is an epidural hematoma

Answer 31

- bleeding above the dura mater, between the dura mater & bones of the cranium (which are typically firmly attached)

Question 32

what is a subdural hematoma

Answer 32

- accumulation of blood within the potential space between the dura & arachnoid mater

Question 33

describe the onset of symptoms for a subdural hematoma (3)

Answer 33

- can occur within 24 hrs after injury (acute) - can develop slowly, about a week after (subacute) - or weeks later (chronic)

Question 34

what is an intracerebral hematoma

Answer 34

- accumulation of blood within the cerebrum

Question 35

what can cause an intracerebral hematoma

Answer 35

- contusion - shearing injury - stroke

Question 36

what manifestations does primary damage to the head often cause

Answer 36

- focal injuries = symptoms based on what part of the brain was effected

Question 37

what do secondary injuries often result in

Answer 37

- increased ICP

Question 38

list 4 other symptoms of head injuries

Answer 38

- seizures - cranial nerve damage - otorrhea, otorrhagia, rhinorrhea - fever

Question 39

how can head injuries cause seizures

Answer 39

- the blood & inflammation can irritate neural tissue = lose electrical control = seizures - also the release of K+ from damaged neurons

Question 40

what is cranial nerve damage common in

Answer 40

- basilar fractures

Question 41

what is otorrhea, otorrhagia, and rhinorrhea

Answer 41

- CSF of blood leaking from the ear or nose

Question 42

what 2 signs does otorrhea, otorrhagia, and rhinorrhea cause

Answer 42

- raccoons eye = bruising around the eyes | - battle sign = bruising behind the ear

Question 43

what do otorrhea, otorrhagia, and rhinorrhea cause

Answer 43

- increases the risk of infection

Question 44

how can head injuries cause fever

Answer 44

- infection | - hypothalamic impairment (important role in temp)

Question 45

what can mask the early signs of increased ICP? (2)

Answer 45

- alcohol & drugs

Question 46

how do drugs & alcohol mask the signs of increased ICP

Answer 46

1. have similar symptoms | 2. causes dehydration

Question 47

how does dehydration associated w alcohol mask the signs of increased ICP

Answer 47

- makes the injury seem better in the beginning bc dehydration = decreased P - but, once the alcohol is metabolized it produces a vasodilator = increased P by dilating vessels in the brain

Question 48

what complication may occur if there is increased ICP?

Answer 48

- pressure on brainstem = 1. decreased cough reflex 2. decreased RR = risk of pneumonia is the pt is laying prone

Question 49

what can worsen neurological symptoms & brain damage

Answer 49

- hypoxemia