Types of head injury
What is contusion
Bruising of brain tissue
what are the three main responses the Glasgow coma scale tests?
eye-opening, verbal and motor
what are the layers of the meninges?
dura mater, arachnoid mater and pia mater
what is normal ICP?
7-15mmHg
A patient is admitted with a low level of consciousness. His CT is shown below:
extradural haemorrhage
A patient who sustained a traumatic brain injury has impaired consciousness, Glasgow Coma Scale score of < 15, focal neurologic findings, and suspected fracture. Which of the following is the most appropriate initial imaging step?
CT scan
Raised intracranial pressure compresses the _________ nerve against the temporal bone
oculomotor nerve (CNIII)
how does the brain compensate for raised ICP?
reduces venous drainage and csf
A middle-aged man presents with a head injury after falling down some stairs. After losing consciousness he quickly recovers but complains of a headache. Over the next few hours, he becomes more confused and has one seizure
what kind of haemorrhage does he have?
Extradural haematoma
When treating a traumatic brain injury (TBI) patient, what three H's should you avoid?
hyperventilation, hypoxia, hypotension
An elderly alcoholic is admitted after falling over. His CT scan is shown below:
subdural haemorrhage
A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an ICP of 20 mmHg. Should you be worried if so why?
Yes, vasodilation which will increase ICP
A patient is admitted after collapsing shortly after complaining of a headache:
subarachnoid haemorrhage
What pain relief medications should be avoided when treating a TBI during the first 24hrs?
aspirin, ibuprofen, and naproxen sodium
A 21-year-old woman was admitted to the hospital with a headache. She denies any preceding trauma before the onset of the headache. She was sitting watching television when the headache started around her occiput. The headache peaked within 2 seconds and the pain was rated at 10/10. This is her first headache and she did not have any headaches in the past. Glasgow Coma Scale 15/15 was noted on examination.
what is your diagnosis?
subarachnoid haemorrhage
A 40-year-old obese woman has a recent diagnosis of idiopathic intracranial hypertension and has recently noticed a blurring of her vision. Her mean arterial pressure (MAP) is measured at 93mmHg. A CT head is reported to not show any signs of intracranial bleeding.
The doctors decide to perform a lumbar puncture and record an opening pressure of 30cmH2O. The patient's vision begins to deteriorate further and she is taken to a neurosurgical centre where they measure her intracranial pressure (ICP). The ICP is recorded as 40mmHg. what is their cerebral perfusion pressure?
53mmHg
A 10-year-old boy is brought to the emergency department via ambulance after he was involved in a motor vehicle collision. The patient is unconscious on arrival. Glasgow Coma Scale (GCS) score is 8. CT scan does not show any specific lesion. The patient remains unconscious for the next 7 hours. Based on these findings, which of the following is the most likely diagnosis?
Diffuse axonal injury
what are these red flags a sign of:
basal skull fracture
Specific types of skull fractures can result in special risks to the patient. One of these risks includes damage to facial, acoustic, and vestibular nerve function. Fracture of which of the following structures will increase a patient’s risk of this type of damage?
a) occipital bone b) parietal bone c) temporal bone d)carotid canal
occipital bone
_________ herniation can lead to compression of the oculomotor nerve, causing a dilated pupil and "down and out" gaze in the ipsilateral eye
Uncal herniation