DR Medhat MRCP

Traumatic brain injury:
Extradural
(=epidural)Hematoma
Subdural
Hematoma
Subarachnoid
Hemorrhage
- Often results from trauma or a blow to the side of the head.
- The majority occur in the temporal region where skull
fractures cause a rupture of the middle meningeal artery.
يقوم عادي بعد الخبطه وبعدها بنص ساعه يقع ويغيب عن الوعي Features
1. Features of raised intracranial pressure
سؤال هام 2. Some patients may exhibit a lucid interval
3. Ipsilateral dilated pupil (transtentorial coning)
followed by bilateral dilated fixed pupils.
Initial TTT : I.V mannitol (↓ brain oedema)
- Most commonly occur around the frontal and parietal lobes.
- Fluctuating conscious level & impaired cognitive function are
important finding
- Bilateral papilloedema , hemiparesis.
- Risk factors old age, alcoholism and anticoagulation.
- Usually occurs spontaneously in the context of a ruptured
cerebral aneurysm but may be seen in association with other
injuries when a patient has sustained a traumatic brain injury
Intracranial Venous Thrombosis
- Can cause cerebral infarction, much less common than arterial causes.
- 50% of patients have isolated sagittal sinus thromboses , the remainder have
coexistent lateral sinus thromboses and cavernous sinus thromboses
Features
1. Headache (may be sudden onset)
2. Nausea & vomiting.
3. Papilledema
4. Individual features :
Sagittal sinus thrombosis Cavernous sinus thrombosis Lateral sinus
thrombosis
Most common (50%) Fever with rigors
Cr6 ,7 palsy.
Headache(morning,
fronto-occipital)
Seizures
Unilateral eye & forehead pain and
swelling (edema)
Ophthalmoplegia (Cr3,4,6 palsies)
Hemiplegia
Cr5 involvement facial
Corneal spared Cr3 palsy hyperthesia & eye pain.
TTT :
I.V then PO
anticoagulation (if 1ry).
Drainage + Abx if inf.
63
Risk factors :
1) Oral contraceptives
2) Post-partum
3) Hypercoagulable state