Traumatic Brain Injury and Contusion Management — WACS Viva & Clinical Scenarios (Neurotrauma and Craniofacial Emergency Surgery)

Exam-style traumatic brain injury and contusion management viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male motorcyclist is transported to the accident and emergency center following a collision. Initial assessment reveals a Glasgow Coma Scale (GCS) score of 6 (Eye 1, Verbal 2, Motor 3), blood pressure of 85/50 mmHg, heart rate of 128 beats per minute, and SpO2 of 87% on room air. Formulate the immediate resuscitation protocol adhering to Advanced Trauma Life Support (ATLS) and neurotrauma guidelines, detailing the physiological thresholds required to mitigate secondary ischemic brain injury.
• SCENARIO 2: A 35-year-old female sustains severe closed traumatic brain injury (post-resuscitation GCS 7). Initial non-contrast cranial CT reveals Marshall Diffuse Injury Class III (compressed basal cisterns without high- or mixed-density mass lesions >25 cm3). Detail the clinical indications for invasive intracranial pressure (ICP) monitoring, compare an external ventricular drain with an intraparenchymal strain-gauge catheter, and outline an algorithmic, tiered medical protocol for managing sustained ICP elevations above 22 mmHg.
• SCENARIO 3: Explain the biomechanical differences between translational and angular acceleration-deceleration mechanisms in the genesis of cerebral contusions and diffuse axonal injury. Describe the cellular and vascular mechanisms driving the contusion blossoming phenomenon within 24 to 72 hours post-injury, and provide the clinical and radiological criteria mandating routine interval repeat CT scanning.
• SCENARIO 4: A 45-year-old male with an initial GCS of 11 is admitted with a right temporal polar contusion measuring 22 cm3 with 4 mm of midline shift and patent basal cisterns on CT. At 36 hours post-admission, his GCS drops acutely to 7, and his right pupil becomes 5 mm and sluggishly reactive. State the definitive indications for emergency surgical intervention, describe the operative steps of a right trauma frontotemporoparietal craniectomy, and detail the technical principles of contusion evacuation and duraplasty.
• SCENARIO 5: Discuss the timing, drug selection, and monitoring parameters for post-traumatic seizure prophylaxis, early enteral nutrition, and venous thromboembolism (VTE) chemoprophylaxis in a comatose patient with multi-focal cerebral contusions. Outline how the IMPACT and CRASH prognostic models are utilized to estimate mortality and functional outcomes at six months.