Tag Archives: Trauma
Upper motor neuron lesion: Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation. Clinical features: Sparing of the forehead muscles Asymmetry of face at rest or on movement: smile, puffing the cheeks and on wincing The palpebral fissure may be widened on the affected side Investigations to consider: … Continue reading Isolated Facial palsy, CN VII
Superior Orbital Fissure Syndrome
Synonyms: Anterior cavernous sinus syndrome, Rochon-Duvigneaud’s syndrome Diagnosis: This is a clinical diagnosis. Underlying causes are identified by investigations and clinical assessment. Dysfunction of cranial nerves oculomotor (III), trochlear (IV), abducens (VI) and first division of the trigeminal nerve (V1). Also sympathetic fibers may be involved causing a Horner syndrome (this becomes cavernous sinus syndrome). … Continue reading Superior Orbital Fissure Syndrome
Abducens (cranial nerve VI palsy)
Diagnosis: This is a clinical diagnosis Clinical features: Horizontal diplopia In neutral gaze, normal appearance or head is slightly turned to the unaffected side (compensation for unopposed medial rectus) On movement: Affected eye fails to abduct Investigations to consider: Blood tests: ESR: giant cell arteritis TFT, glucose ANCA: Wegner’s granulomatosus HbA1c ESR CT: Out rules … Continue reading Abducens (cranial nerve VI palsy)
Trochlear Nerve Palsy (Cranial IV palsy)
Diagnosis: This is a clinical diagnosis Clinical features: Rare in isolation In neutral gaze: slight head tilted contralateral to the weak superior oblique muscle (loss of in-torsion) Test with eye adducted and moved inferiorly. This is also the position of worse diplopia If bilateral: on horizontal gaze, the abducting eye drifts downwards (inferior rectus of … Continue reading Trochlear Nerve Palsy (Cranial IV palsy)
Klüver-Bucy syndrome
Diagnosis: This is a clinical diagnosis Clinical features: Hypersexuality, hyperorality, visual agnosia, and placidity (diminished emotional reactions). Investigations to consider: MRI: Lesions in bilateral medial temporal lobes, e.g. Traumatic brain injury, herpes, other infections Consider tests for dementias (FTLD, Alzheimer’s) & infections Related articles: Traumatic brain injury, encephalitis, frontotemporal dementia, Alzheimer disease,
Raised Intracranial Pressure, raised ICP
This is an abnormality that can occur due to multiple potential causes. It is treated based on the underlying cause and severity. Diagnosis: Intracranial pressure monitoring: Ventriculostomy (external ventricular drain EVD) Implantable ICP monitor Lumbar drain Raised opening pressure on Lumbar puncture (e.g. in cases of pseudotumor cerebri or meningitis). This should not be performed … Continue reading Raised Intracranial Pressure, raised ICP
Cerebral Edema
This is an abnormality that can occur due to multiple potential causes. It is treated based on the underlying cause and severity. Diagnosis: CT: Hypodensity Local effacement of sulci and ventricles and cisterns Blurring of the grey-white interface MRI: DWI: Allows differentiation between vasogenic (no abnormal diffusion restriction) vs. cytotoxic (abnormal diffusion restriction) types of … Continue reading Cerebral Edema
Traumatic nerve root avulsion
Diagnosis: Clinical +electrophysiology or CT myelogram: Trauama, flaccid paralysis, areflexia NCS/EMG: Fibrillation & positive sharp waves PSW in paraspinous muscles SNAP: Normal conduction velocity in affected area (i.e. preganglionic) SSEP: Absent cortical response in affected segment CT myelogram: Avulsed nerve roots
Diffuse Axonal Injury
Diagnosis: Neuroimaging +Clinical features Clinical features: Coma after head trauma: low GCS <8, with or without features to suggest structural cause (dilated pupills, disconjugate gaze, asymmetric posturing) Raise intracranial pressure (ICP ) often occurs Neuroimaging: CT: May be normal May show petechial hemorrhages in the whitematter (corpus callosum, corona radiata, cerebral peduncles) May show diffuse … Continue reading Diffuse Axonal Injury
Cerebral Contusion
Diagnosis: CT: Cerebral edema (hypodensity on CT) in the cortex or lobe at the site of injury or opposite location (counter-coup) or distant site where impact occurs at areas of the skull Hemorrhage (hyperdensity on CT) within the areas of contusion are typical. They involve the cortex and extend subcortically to a variable extent Frontal … Continue reading Cerebral Contusion
Subdural Hematoma
Synonyms: Subdural haematoma Diagnosis: CT: Crescent shaped, diffuse covering a large part of the hemisphere Can be biconvex in shape Can be of mixed density: e.g. Fluid-fluid level Cross suture lines but not the midline Variation with time: Acute, hyperdense, homogenous Middle, isodense with brain Chronic: hypodense Acute on chronic: heterogenous, fluid-fluid levels Pathology: Acute: … Continue reading Subdural Hematoma
Epidural Hematoma
Synonyms: Extradural hematoma Diagnosis: CT or MRI: Biconvex shape a.k.a. ‘lentiform’, usually over the temporal lobe Can cross the falx, tentorium, can cross the midline, but doesn’t cross the suture lines Associated with skull fracture Clinical features: Usually there is a history of trauma Often the patient is knocked unconscious with the initial trauma. They … Continue reading Epidural Hematoma
Concussion
Diagnosis: Clinical Classification: Grade 1: Transient confusion; no loss of consciousness; concussion symptoms clear in less than 15 minutes. Grade 2: Transient confusion; No loss of consciousness; concussion symptoms or mental status abnormalities last longer than 15 minutes. Grade 3: Any loss of consciousness, either brief (seconds) or prolonged (minutes). Treatment: Return to play (quick … Continue reading Concussion
Traumatic Brain Injury
Synonyms and related terms: Head trauma a.k.a. head injury a.k.a. traumatic brain injury TBI Diagnosis: Clinical With or without neuroimaging: CT more commonly than MRI, Classification, the Glasgow coma scale GCS was designed for this: Mild: GCS 13-15 Moderate: GCS 9-12 Severe: GCS = or <8 Critical: GCS 3-4 Treatment: If mild: Consider discharge or … Continue reading Traumatic Brain Injury