Understanding Brain Herniations and Their Clinical Implications

Core Questions

1. Define mild, moderate, and severe TBI (including Box 34.1). 
2. Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant? 
   • Primary and secondary brain injury. 
   • direct and indirect brain injury. 
3. Differentiate between: 
4. Describe the 4 herniation syndromes 
5. List the extra-axial brain injuries 
6. List the intra-axial brain injuries 
7. Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes). 
8. Describe key imaging findings in the main types of traumatic brain injury. 
   • Inititial resuscitation 
   • ICP management and hyperosmolar therapy
   • Indications for seizure and antibiotic prophylaxis 
   • Reversal of anticoagulation 
   • Decompressive therapies 
9. Outline your management priorities in TBI with respect to: 
10. List the complications of TBI. 

Wisecracks

1. What are the layers of the scalp? 
2. What is the Munro-Kellie doctrine? 
3. What is Cushing’s reflex? 
4. List the clinical features of basal skull fracture (Box 34.2) 
5. Describe 3 clinical decision rules that apply to  neuroimaging in mild TBI. 
6. Describe a graduated return to play protocol as per Rosen’s.