Clinical Manifestations
What are clinical manifestations of a cortical contusion?
-immediate, brief loss of consciousness
-changes in attention and memory
Does an open or closed head injury have a higher infection risk?
Open!
What is the most common type of intracranial bleeding?
Subdural hematoma
What does a post-concussion syndrome mean?
Psychological, physiological, and/or social problems caused by the original concussion can last up to a year after the fact
What are the classic symptoms of an epidural hemorrhage?
Immediate loss of consciousness, followed by waking up and lucidity, rapidly followed by losing consciousness again.
What is a coup-contrecoup injury?
An injury caused sudden acceleration or deceleration of the head, which causes the brain to smack both sides of the skull.
Coup: initial injury
Contrecoup: the subsequent injury, occurring on the opposite side of the initial impact site
What are potential causes of chronic subdural hematomas?
-aneurysms (especially in the elderly)
-alcoholics (decreased clotting capabilities)
-shaken baby syndrome
What is the best scan to see if someone has experienced a diffuse axonal injury?
An MRI is the best way to see.
What is the classic symptom of a subdural hematoma?
A slow decrease in level of consciousness.
What is a focal brain injury?
An injury confined to one area of the brain, resulting from an impact to the head.
Bonus Q: list some types of focal brain injuries (+50 pts for each type, 4 are listed on the slide)
What is at least one possible cause of a subarachnoid hemorrhage?
-ruptured aneurysm
-arteriovenous malformation (AVM)
-head trauma (especially at the base of the skull)
If someone has been in a coma or has lost consciousness for over 6 hours, what type of brain injury do you suspect this is?
A diffuse axonal injury.
What are at least 2 of the clinical manifestations of a chronic subdural hematoma?
-headache
-drowsiness
-confusion (looks like slow onset dementia)
-possible herniation
What type of damage does a diffuse brain injury cause?
Shearing, tearing, or stretching of nerve fibers that result in widespread/diffuse axonal injury. Caused by rotational acceleration and deceleration.
Where is the bleeding happening in an intracerebral hematoma?
In the parenchyma of the brain tissue.
Bonus Q: What causes an intracerebral hematoma?
What are potential surgical treatments for a brain injury?
-evacuation of the hematoma, bone fragment, or foreign matter causing the problem
-craniotomy to relieve intracranial pressure
What are at least 3 clinical manifestations of meningeal irritation seen in a subarachnoid hemorrhage?
This will present like meningitis so it will include:
-positive Kernig’s and Brudzinski sign
-Neck stiffness
-Photophobia, blurred vision
-Irritability, restlessness
-Low grade fever
-sudden significant headache
What is a cortical contusion?
A small tear in vessels or the surface of the brain.
Bonus Q: What are potential consequences of this?
If there is scarring of the arachnoid villa, what might eventually happen?
It can impair CSF absorption and lead to hydrocephalus
What are at least 3 supportive treatment options we can do for a patient with a traumatic brain injury?
-Close observation for signs of change in neurologic status
-Cleaning and debridement of wounds
-Diuretics
-Analgesics
-Anticonvulsants
-Respiratory support
-Prophylactic antibiotics if indicated