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TRAUMATIC
BRAIN INJURY and
HEAD INJURY are
often used
Head Injury
Causes
Motor vehicle accidents
Falls
Assaults
Sports-related injuries
Firearm-related injuries
HEAD INJURY - TYPES
OPEN HEAD INJURY: CLOSED HEAD INJURY
There is penetration to the skull. There is NO penetration to the skull.
COUP-CONTRECOUP
INJURIES
Cerebral Contusion
Impaired Metabolism
Epidural Hematoma
Subdural Hematoma Altered Cerebral Blood Flow
Subarachnoid Hematoma
Intracerebral Hematoma Free Radical Formation
Diffuse Axonal Injury
Excitotoxicity
SCALP INJURIES
LACERATIONS SUBGALEAL HEMATOMA
Head Injury
Scalp lacerations
The most minor type of head trauma
Scalp is highly vascular profuse
bleeding
Major complication is infection
SKULL INJURIES
CLOSED FRACTURES OPEN FRACTURES
Open fractures have
potential for serious
infection.
A closed fracture has a Any foreign matter impaled
significant chance of in the skull should be left in
associated intracranial place for removal by the
haematoma. neurosurgeons.
Cover it lightly with a sterile
dressing that has been
moistened with a sterile
saline.
SKULL INJURIES
CT SCAN OT
SKULL INJURIES
DEPRESSED FRACTURES/COMPOUND
NON-DEPRESSED LINEAL
DEPRESSED FRACTURES FRACTURES
SKULL INJURIES - BASILAR
SKULL FRACTURE
BRAIN INJURIES
DIFFUSE FOCAL
Contusion
Brain Lacerations
Concussion Epidural haematoma
Diffuse Axonal Injury Subdural haematoma
Subarachnoid haemorrhage
Parenchymal haematoma
SKULL INJURIES - BASILAR
SKULL FRACTURE
RACCOON EYE
SKULL INJURIES - BASILAR
SKULL FRACTURE
BATTLES SIGN
SKULL INJURIES - BASILAR
SKULL FRACTURE
BLEEDING FROM THE EAR CSF LEAKAGE FROM THE
CANAL EAR OR NOSE
Head Injury
Contusion
Brain Lacerations
Concussion Epidural haematoma
Diffuse Axonal Injury Subdural haematoma
Subarachnoid haemorrhage
Parenchymal haematoma
HEAD INJURY (DIFFUSE) -
CONCUSSION
Brain injury that does There may be brief
not result in any confusion,
evidence of structural disorientation,
alteration. headache, dizziness,
amnesia.
Return of
consciousness CT scan is normal.
moments or minutes
after impact.
Head Injury
Pathophysiology
MILD 13-15
MODERATE 9-12
SEVERE 3-8
GLASGOW COMA SCALE
(GCS)
LOSS OF
SEVERITY CONSCIOUSNESS
Vasospasm, Aneurysm
Skull fractures
Linear Skull Fracture
Depressed Skull Fracture
Diastatic Skull Fracture
Basal Skull Fracture
Compound Skull Fracture
Compound elevated Skull Fracture
Growing Skull Fracture
Battles Sign
Fig. 55-13
Investigations
X-ray
CT scan: standard modality
MRI
Epidural Hematoma
Subdural Hematoma
Fig. 55-15
Subdural hematoma
Occurs from bleeding between the dura mater and
arachnoid layer of the meningeal covering of the
brain
Source of bleed: Bridging veins; May be caused by
an arterial hemorrhage
Much slower to develop into a mass large enough to
produce symptoms.
Cause: Acceleration-deceleration injury, direct
trauma,
Risk factors: Elderly, dementia, alcoholics, shaken
baby syndrome, pts on anticoagulants
Subdural hematoma
Location Between the skull and the dura Between the dura and
the arachnoid
Involved vessel Temperoparietal (most likely) - Bridging veins
Middle meningeal artery
Frontal - anterior ethmoidal artery
Occipital - transverse or sigmoid
sinuses
Vertex - superior sagittal sinus
Symptoms Lucid interval followed Gradually
by unconsciousness increasing headache and co
nfusion
CT appearance Biconvex lens- limited by suture Crescent shaped- crosses
lines suture lines
Fig. 55-15
Subarachnoid Hemorrhage
Causes:
Rupture of Berry aneurism(MCC)
Trauma (fracture at the base of the skull leading to
internal carotid aneurysm)
Amyloid angiopathy
Blood dyscrasias
Vasculitis
Clinical Features:
Explosive or thunderclap headache, worst headache
of my life,
nausea and vomiting, decreased LOC or coma.
Signs of meningeal irritation
Intracerebral Hemorrhage
(ICH)
Intracranial hemorrhage is hemorrhage that occurs
within the brain tissue itself; an intra-axial
hemorrhage.
Two main types:
1)Intraparencymal hemorrahge- ICH extending into
brain parenchyma; MCC- HTNsive vasculopathy
2)Intra-ventricular hemorrhage- ICH extending into
ventricles; MCC trauma
Causes:
Hypertensive vasculopathy(70-80%)
Ruptured AVM
Trauma
Blood dyscracias
Intracranial Hemorrhage
Extra- axial hemorrhage
Epidural hematoma
Subdural hematoma-
Acute
Chronic
Subarachnoid hemorrhage
Intra-axial hemorrhage
Intra-parenchymal
hemorrhage
Intra-ventricular
hemorrhage
Intracerebral Hemorrhage
(ICH)
Clinical presentation: Rapidly progressive severe headache,
building over several minutes, often accompanied by focal
neurological deficits, nausea and vomiting, decreased level of
consciousness.
Clinical feature:
Compression of I/L CN III- I/L fixed dilted pupil
Compression of I/L PCA- C/L homonymous hemianopsia
Compression of C/L crus cerebri- I/L hemiparesis
Duret hemorrhage
Diagnostic Studies
CT scan
A GCS score less than 15 after blunt
head trauma warrants a patient with no
intoxicating consideration of an urgent
CT scan.
CT findings
Fig. 55-15
CT findings
Fig. 55-15
Diagnostic Studies
Exception :
In Subdural hematoma with GCS=15- hematoma >10mm ,or
>5mm midline shift ---- requires Surgical decompression
Burr-hole
Craniotomy- bone flap is temporarily removed from
the skull to access the brain
Craniectomy in which the skull flap is not immediately
replaced, allowing the brain to swell, thus reducing
intracranial pressure
Cranioplasty - surgical repair of a defect or deformity of
a skull.
TREATMENT - ACUTE STAGE
(SURGERY)
DECOMPRESSIVE CRANIOTOMY
Management
4) Medical therapy:
Health Promotion
Prevent car and motorcycle
accidents
To Wear safety helmets
Rehabilitation
Ambulatory and Home Care
Nutrition
Bowel and bladder management
Spasticity
Dysphagia
Seizure disorders
Family participation and education