HEAD TRAUMA

Neurologic Assessment

Levels of consciousness

Glassgow coma scale

Cranial nerve assessment

 Definition – Traumatic Brain Injury
(TBI)
is a result of an external mechanical
force to the brain that leads in a change to
cognitive, physical, psychosocial
functioning associated with
altered state of consciousness.
The impairments can be temporary or permanent
Risks Factor
Risks Factor
Risks Factor
• Firearms
 Traumatic Brain Injury
Primary Brain Injury Secondary Brain Injury
Results from what has Physiologic and
occurred to the brain at biochemical events
the time of the injury which follow the
primary injury
 Categories of Brain Injuries
Closed (Blunt) Brain Injury
Acceleration/Deceleration Non-Acceleration
If a moving object hits a Much more rare,
movable head (e.g. referred to as a
head gets hit with a bat) crushing injury
If a moving head hits If a moving object hits
something stationary a head that is fixed
Shaken type of (e.g. car falls on head
movement while you’re working
(e.g. when head rocks under it).
back and forth in skull).
 Categories of Brain Injuries
Open Brain Injury
Low Velocity High Velocity
Skull is no longer Bullets penetrate the
intact, part of skull or skull and goes into the
debris gets into the brain matter.
brain.
CAUSES OF BRAIN INJURIES
Coup and Countercoup Injuries
Concussion vs Contusion
Diffuse Axonal Injury
Epidural Hematoma
Subdural Hematoma
Intracerebral Hemorrhage
Compound fracture
Penetrating injury
 The energy of impact from a small
hard object tends to dissipate at the
impact site, leading to a COUP
contusion

Impact from a larger object

causes less injury at the impact
site, since the energy is dissipated
at the beginning or end of the
head motion.
 Contusion
Bruising type of injury to the brain resulting
to sudden loss of consciousness or
coma. Contusion may occur with
subdural/ extradural collection of blood,
intracerebral hemorrhage.

Contusion is considered severe form of

axonal injury with shearing of blood.
 Concussion
Mild bruising to the cerebral tissue cause
by jarring of the brain resulting in
transient
loss of consciousness.

Concussion is considered a mild form of

diffuse axonal injury
 Categories of Diffuse Brain Injury
Mild Concussion (without LOC)
Grade I confusion disorientation with amnesia
Grade II confusion and retrograde amnesia (5-10 min)
Grade III confusion with retrograde and anterograde.

 Immediate but transitory clinical manifestation.

 CSF pressure rises, ECG, EEG changes.
 Confusion last for several minutes.
 with amnesia for events preceding the trauma.
 head pain, nervousness and not being themselves.

5
 Categories of Diffuse Brain Injury
 (grade IV) Classic Cerebral Concussion

diffuse cerebral disconnection from brain.

retrograde and anterograde amnesia. May
experience post-concussive syndrome.

Vital signs quickly stabilized

Confusion for hours to days.
Head pain, fatigue, nausea, inability to concentrate and
forgetfulness, mood and affect changes.
Diffuse Axonal Injury
Diffuse axonal injury is characterized by
extensive generalized damage to the
white matter of the brain

Strains during high-speed

acceleration/deceleration produced in
lateral motions of the head may cause the
injury.