U of U PA School Head and Neck Trauma

How should a small or low ICP epidural hematoma be managed?

Osmotics (mannitol)

Hyperventilation

How is a severe epidural hematoma managed?

Surgery

Why are subdural hematomas not drained? When are they drained?

Eventually reabsorbed

Drained if mass effect or intolerable symptoms

What risk is common after a subdural hemorrhage?

Rehemorrhage

What is the most common location for bleeding due to head trauma?

Subarachnoid hemorrhage

-Rupture of any artery in subdural space

How do outcomes for subarachnoid aneurysms versus trauma differ?

Outcome for subarachnoid hemorrhage due to trauma better

What are the acute risks of a subarachnoid hemorrhage?

Spasms

Seizure

Stroke

What is a concussion?

Trauma induced AMS

May or may not have loss of conscious

What indicates a more severe concussion?

Longer period of unconsciousnes

What symptoms appear within minutes to hours of a concussion?

Headache

Lack of awareness of surroundings

Nausea/vomiting

What symptoms appear after hours of a concussion? (4)

Mood and cognitive disturbances

Sleep disturbances

Sensitivity to light/noise

Amnesia

What neuropsychiatric symptoms are common from a concussion? (5)

Vacant stare

Irritability

Slurred speech

Memory deficits

Disorientation

What can multiple concussions in a row cause?

Permanent neuropsychiatric changes

Who are TBI guidelines used for? (4)

Patients with non penetrating trauma to head

Present to ED within 24 hours of event

GCS of 14 to 15

16+ years old

When do TBI guidelines recommend a non-contrast head CT? (8)

Loss of consciousness or posttraumatic amnesia +1 of the following

-Headache

-Vomiting

->60 years old

-Substance intoxication

-Claviular trauma

-Focal neurologic deficit

-Coagulopathy

When do TBI guidelines say a non-contrast head CT should be considered? (8)

No loss of consciousness or posttraumatic amnesia but does have one of the following

-Headache

-Vomiting

-Focal neurologic deficit

->65 years old

-Signs of a basilar skull fracture

-Coagulopathy

-Dangerous MOI

How is a concussion managed? (4)

Prohibit return to play until concussion resolved - asymptomatic off of meds

More caution warranted the younger in age

Physical rest for 24-48 hours

Early vestibular or balance rehab

What is post concussive syndrome?

Change in personality or level of functioning that may last for months following concussion

Symptoms difficult to manage and improve with time

What is the treatment for post concussive syndrome?

Frequent mental breaks

Trial of migraine prevention meds

Early intervention is preferred

Where are arterial dissections most common?

Areas where arteries are mobile and in close proximity to bone

-Carotid

-Vertebral

How does a carotid artery dissection present?

Face and temporal pain

Neurologic deficits in carotid territory if it strokes

Horners Syndrome

How does a vertebral artery dissection present?

Posterior head or eye pain

Neurologic deficits in posterior circulation if it strokes

When is the risk of stroke highest from an arterial dissection?

1st week

How is an arterial dissection diagnosed?

Vessel wall imaging

-CTA head and neck

-MRA head and neck + contrast

What can cause an arterial dissection?

Chiropractic adjustment

Lifting heavy objects

Sudden movements

What condition increases the risk of arterial dissection from sudden movement?

Ostephytes

What is the treatment for arterial dissection?

Prevent a stroke

-Antiplatelets

-Anticoagulants

How long should treatment for an arterial dissection last?

3-6 months

What type of arterial dissection is most common?

Vertebral dissection - more osteophytes