Transcript Thrombosis of the Cerebral Veins and Sinuses

Introduction
 Mild traumatic brain injury is commonly defined as Glasgow
Coma Scale (GCS) score on hospital arrival of 13 to 15
 Traumatic brain injury victims harboring hematomas are not
readily identified on neurologic examination or skull radiography
and often do poorly if diagnosis is delayed
 Cranial computed tomography (CT) scanning plays an important
role in the assessment of patients with suspected hematoma
CT scans are more expensive
To avoid its attendant exposure to potentially harmful radiation
Importance
 Numerous clinical decision aids(6) exist to help
decide which head injury patients might benefit from
cranial computed tomography.
 Compare the instruments according to their
sensitivity and specificity  To benefit of correctly
classifying patients as having surgical, nonsurgical,
or no intracranial lesions
nonsurgical lesions (cerebral contusion, subarachnoid
hemorrhage, etc)
Canadian CT Head Rules
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CT of the head is only required for patients with a history of mild head injury
within the previous 24 hours and any one of the following risk factors for
neurological intervention: (also consider Additional Head CT Indications below).
This decision rule is limited by including only patients with loss of consciousness
and anterograde amnesia. It also excluded those with abnormal neurologic
findings, those on anticoagulants and those with seizures. There has been
extensive external validation.
1. High Risk (for neurological intervention)
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GCS < 15 at two hours after injury.
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Suspected open or depressed skull fracture. This is a clinical rather than
X-ray diagnosis.
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Any sign of basal skull fracture (hemotympanum, "raccoon" eyes,
cerebrospinal fluid otorrhea/rhinorrhea, Battle's sign).
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Vomiting 2 or more episodes.
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Age > 65.
2. Medium Risk (for brain injury on CT)
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Amnesia before impact > 30 minutes
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Dangerous Mechanism (pedestrian struck by motor vehicle, occupant
ejected from motor vehicle, fall from height >3 feet or 5 stairs).
Criteria proposed by the NCWFS for classification,
diagnosis, and treatment of patients with mild head injury
New Orleans Criteria for Determining if CT Is
Indicated After Minor Head Injury
 CT is needed if the patient meets one or more of the
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following criteria:
1. Headache
2. Vomiting
3. Age older than 60 years
4. Drug or alcohol intoxication
5. Persistent anterograde amnesia (deficits in short-term
memory)
6. Visible trauma above the clavicle
7. Seizure
*-Applicable for adults with a normal Glasgow Coma Scale
score of 15 and blunt head trauma that occurred within the
previous 24 hours that caused loss of consciousness, definite
amnesia, or witnessed disorientation.
NEXUS II - Decision Instrument
(USA)
 evidence of significant skull fracture
 scalp hematoma
 neurologic deficit
 altered level of alertness, abnormal behaviour
 coagulopathy
 persistent vomiting
 age 65 or more
National Institute of Clinical Excellence
Criteria for immediate request for CT scan of the head (adults)
 GCS less than 13 on initial assessment in the emergency
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department.
GCS less than 15 at 2 hours after the injury on assessment in
the emergency department.
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes,
cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than one episode of vomiting.
Amnesia for events more than 30 minutes before impact.
Scandinavian Neurotrauma Committee
guidelines (Scandinavian)
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Therapeutic anticoagulation or hemophilia
Radiographically demonstrated skull fracture
Clinical signs of depressed skull fracture or skull base fracture
Posttraumatic seizures
Shunt-treated hydrocephalus
Multiple injuries
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