Head Injury MCQs

Meningitis is a feared complication of neurosurgery and head injury. CT scan allows exclusion of raised intracranial pressure and should be done prior to lumbar puncture. CSF should be sent for microscopy and culture, along with protein and glucose level assay. Treatment is with broad spectrum antibiotics including anaerobic coverage. Empirical therapy is started with 3rd generation cephalosporin + Vancomycin ± Ampicillin . Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 48, Cranial neurosurgery, Pg: 706

Explanation: During prolonged ischemia, cells lose membrane integrity and release potassium and acid into surrounding tissues. Once reperfusion occurs, this accumulated potassium rapidly enters the systemic circulation. This sudden potassium surge can cause myocardial depression, dangerous cardiac arrhythmias, vasodilation, worsening hypotension and can contribute significantly to multi organ injury. During ischemia: Cells lose ATP and membrane pumps begin to fail Potassium leaks out of cells into the interstitial space Acidity increases due to anaerobic metabolism Inflammatory pathways are activated locally During reperfusion: The accumulated potassium and acids enter systemic circulation Inflammatory mediators and cell fragments activate leukocytes These changes may contribute to acute lung injury, acute kidney injury and multi organ failure

Explanation: The Glasgow Coma Scale (GCS) reflects the level of consciousness. Scores range from 3 to 15 and assess: Eye opening Verbal response Motor function The motor score alone, not the verbal response, is most reflective of outcomes after traumatic brain injury (TBI). Head Injury Severity & GCS Severity classification of head injury is based on the post-resuscitation Glasgow Coma Scale (GCS) GCS, especially the motor score, is the best predictor of neurological outcome. Alcohol and drugs may complicate assessment. GCS-Based Classification: Minor head injury: GCS 15 with no loss of consciousness (LOC) . Mild head injury: GCS 14 or 15 with LOC . Moderate head injury: GCS 9-13 . Severe head injury: GCS 3-8 . Key Takeaways: Motor component of GCS is the best predictor of TBI outcomes.

GCS classification severity Minor- GCS 15 with no loss of consciousness Mild: GCS 14 or 15 with loss of consciousness Moderate: GCS 9-13 Severe: GCS 3-8

This is a form of primary brain injury seen in high-energy accidents that usually renders the patient comatose; it is associated with poor outcomes. It is strictly a pathological diagnosis made at postmortem, but haemorrhagic foci in the corpus callosum and dorsolateral rostral brainstem on CT may be suggestive, although CT often appears normal Magnetic resonance imaging is more sensitive and is employed to evaluate for difuse axonal injury in patients who fail to improve neurologically. IOC for diffuse atonal injury is SWI-MRI