Brain and Behavior: Head trauma

Types of head trauma: … (4)

epidural, subdural, concussion, contusion

…: a collective term of extravascular accumulation of blood within different intracranial compartments

intracranial hemorrhage

Types of intracranial hemorrhage: … (2)

intra-axial, extra-axial

Complications of hemorrhage: … (3)

mass effect, hydrocephalus, vasospasm

CT is easier to interpret in … (<24hr)

hyperacute blood

… is more sensitive after 12-24 hrs, the most sensitive sequences are the T2W and FLAIR sequence

MRI

…: accumulation of blood between the skull and the dura mater, brain herniation especially uncal herniation may develop as a result of hematoma expansion

Epidural hematoma

Epidural hematoma results from severe head injury with laceration of the …

middle meningeal artery

Classic presentation of epidural hematoma: … (3)

lucid interval, decline in the level of consciousness, rapid progression into coma

CT appearance of epidural hematoma is … between the skull and the dura mater

lens-shaped hyperdense lesion

…: accumulation of blood between the dura mater and the brain, may have acute and chronic presentations

subdural hematoma

Subdural hematoma results from tearing of the … that connect the surface of the brain and the dural sinuses

bridging veins

…: develops shortly after head trauma and can be life-threatening

acute subdural hematoma

Subdural hematoma symptoms: … (4)

headache, contralateral hemiparesis, seizures, cortical dysfunction

If a subdural hematoma is sufficiently large it may … with alteration in the level of consciousness

increase ICP

Subdural hematoma CT scan shows … overlying the brain surface and underlying the skull

crescent-shaped hyperdensity

Subdural hematoma can be distinguished from epidural hematoma by its ability to …

cross suture lines

Epidural hematoma treatment: …

surgical evacuation

…: develops after mild head trauma, common in the elderly especially if on anticoagulants

chronic subdural hemeatoma

Subdural signs and symptoms: … (3)

hemiparesis, seizures, behavioral changes

Subdural hematoma surgical indications: … (2)

rapid expansion of lesion, progressive clinical deficit

…: life-threatening condition, occurs when increased ICP causes a shift of brain contents → compression of brain parenchyma, ventricles, cerebral blood vessels

herniation syndromes

Herniation syndromes: … (4)

subfalcine herniation, central herniation, uncal trans tentorial herniation, tonsillar herniation

…: cerebral peduncle is indented due to a lesion on the opposite side of the brain

kernohans notch phenomenon

…: associated with severe head trauma and may be seen on CT as multiple areas of punctate hemorrhage in the deep white matter and corpus callosum, poor prognosis

diffuse axonal injury

Forces that cause diffuse axonal injury: … (3)

acceleration, deceleration, shearing forces

…: minor head injury causing loss of consciousness, confusion and post-traumatic amnesia, usually a complete recovery

Concussions

Concussions can be caused by: … (3)

acceleration, deceleration, diffuse axonal dysfunction

…: result of mild traumatic brain injury, structural, biochemical, and psychological components have been implicated, normal neuroimaging studies

Postconcussion syndrome

Postconcussion syndrome presents with: … (5)

headache, dizziness, sleep disturbance, cognitive impairment, behavioral abnormalities

…: associated with multiple microhemorrhages due to small blood vessel leaks into the brain tissue, may cause decline in mental function in the long term and brain herniation in the emergency setting

contusion

…: pia-arachnoid membranes are torn over the site of injury

cerebral laceration

Contusion treatment aims to prevent …

dangerous rises in ICP

…: brain impacts against skull upon hitting ground, transmitted forces cause brain to rebound and impact against opposite side of skull

coup-countercoup injury

Glasgow scores of … are classified as mild head injuries

13-15

Glasgow scores of … are classified as moderate injuries

8-12

Glasgow scores of … are classified as sever head injuries

3-7

GCS limitations: … (3)

inaccuracy if patient is intubated, inability to track serial changes, does not diagnosis cause

Normal ICP: …

15 mmHg

Skull is a rigid container with 3 components: … (3) changes in one compromises the other two

brain, blood vessels, CSF

…: the difference between the mean arterial pressure and the ICP, maintain between 60 and 75 mmhg

Cerebral perfusion pressure

Head injury with a GCS of … and … should be monitored int he ICU

9, abnormal head CT

Raised ICP treatments: … (8)

hemicraniectomy, head elevation, hyperventilation, mannitol, hypertonic saline, IV barbiturates, CSF drainage

…: seizures within 1 week of head trauma

early

…: seizures after 1 week of head trauma

late

Seizures post head injury occur in patients with: … (2), 25% of these people will go on to develop epilepsy

intra-cranial hematoma, depressed skull fracture

… reduce the incidence of early seizures but not the risk of developing epilepsy

antiepileptics

Patients who have a … require treatment with anticonvulsants due to high risk for posttraumatic epilepsy

single late seizure