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Head Injury 1

This document discusses different types of head injuries including closed and open head injuries. It describes traumatic brain injury as being caused by an external force to the brain. The highest rates of TBI are among adolescents, young adults and those over 75. Vehicle crashes and falls are the leading causes. Different types of brain injuries are discussed such as contusions, hematomas, lacerations, concussions, and diffuse axonal injury. The Glasgow Coma Scale for assessing head injury severity is also described. Treatment depends on the type and severity of injury.

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drvishal bhatt
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53 views

Head Injury 1

This document discusses different types of head injuries including closed and open head injuries. It describes traumatic brain injury as being caused by an external force to the brain. The highest rates of TBI are among adolescents, young adults and those over 75. Vehicle crashes and falls are the leading causes. Different types of brain injuries are discussed such as contusions, hematomas, lacerations, concussions, and diffuse axonal injury. The Glasgow Coma Scale for assessing head injury severity is also described. Treatment depends on the type and severity of injury.

Uploaded by

drvishal bhatt
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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HEAD INJURY

AND TRUMATIC

BRAIN INJURY

Dr.Mansoor Khan
MBBS, FCPS-I,Resident SCW, KTH, Peshawar
Mar14th, 2009
“Traumatic Brain Injury is an
insult to the brain caused by an
external physical force”
TBI

CLOSED HEAD OPEN HEAD


INJURY INJURY

No obvious external signs, Obvious external wound


resulting from –motor vehicle For example a gunshot wound
crashes, falls, child abuse, or or object penetrating the skull.
domestic violence, child
violence..
Highest among adolescents, young
adults, and those older than 75

50% of major trauma deaths are


due to TBI

Vehicle crashes are the leading


cause of brain injury. Falls are the
second leading cause
Motor Vehicle Crashes Crashes- 44%
Falls - 26%
Other/Unknown - 13%
Non-Firearm Assaults Assaults- 9%
Firearms Firearms- 8%
These days there is a new
category of Head injury ––
BLAST INJURY!
How grave are the conditions!!!!!!!!
The Annual cost of TBI to the U.S.
is equal to one of these
$60.0 Billion!!
M
E
N
I
N
G
E
S
TYPES OF HEAD
INJURY

DIFFUSE AXONAL
CONTUSIONS BLEEDING
INJURY

EXTR-DURAL SUB-DURAL SUB-ARACHNOID INTRA-CEREBRAL


HEMATOMA HEMATOMA HEMORRHAGE HEMORRHAGE
LACERATIONS
Secure ABC
Expose, clean, apply
pressure dressing if
bleeding
CONCUSSION

When the brain suddenly shifts


inside the skull and knocks against
the skulls bony surface.
Concussions can last from a few
moments, to an unconscious state
for over 3 minutes.
CONCUSSION

Grade 1 – conscious, symptoms last under 15 minutes


Grade 2 – conscious, symptoms last over 15 minutes
Grade 3 - unconscious

Grade 1 Grade 2 Grade 3


Allow casualty to Seek professional Call an ambulance
rest, however medical assistance, immediately, lay casualty
down with head and
continually monitor in lay the casualty down
shoulders slightly raised,
case their condition with the head and try to keep them awake
changes. Lay shoulders slightly and talking. If casualty
casualty down with raised. Try to keep falls unconscious and is
their head and casualty awake and not breathing,
shoulders slightly talking commence CPR and
monitor vital signs
raised
Bra
in

ull
Sk
Are
a
bru of
isin
g

Site
imp of
act

Con
bru tusion
i
ma sing o , or
y f
of t occu the br
he r
blo at the ain
w. site

POSSIBLE SITE OF BRAIN INJURY FOLLOWING A


BLOW TO BACK OF HEAD

BRAIN CONTUSIONS
BRAIN CONTUSION

Conduct Primary Survey

If symptoms indicate severe


head trauma, call ambulance

Monitor casualty’s level


of consciousness
If casualty falls unconscious
and breathing ceases, commence
CPR until further help arrives
EXTR-DURAL HEMATOMA

Blow to the temporal, parietal bone


Rupture of the middle meningial
artey

Initial concussion followed by lucid


interval

Respects the suture lines.


Seen on CT Brain as lens-
shaped blood collection
with a convex medial
border .

Carries a 5% to 20% mortality rate


SUB-DURAL HEMATOMA

Severe head injury-Sudden


deceleration injuries

Rupture of a bridging vein

Thin layer of blood in the


subdural space

Crescent-shaped blood collections


with a concave medial border.
This does not resect the suture lines.
Note also midline shift.
SUB-ARACHNOID HEMORRHAGE

Increased attenuation
is seen in the CSF spaces
over the cerebral
hemispheres

Bleeding occurs between


the arachnoid and pia mater
INTRA-CEREBRAL HEMORRHAGE

Injury of the brain substance itself


Associated with cerebral laceration,
contusion, oedema and necrosis
Evacuation of the clots can have poor
results
Not as easy to remedy.
DIFFUSE AXONAL INJURY

Occurs due to shearing forces between


grey and white matter.
Generalized cerebral oedema results
due to parenchymal disruption leadsing
to an increase in ICP
Ranges from mild form-concussion
severe form- persistent vegetative
state
Glasgow coma scale

Confused (GCS 9-14)

Fully conscious (GCS 15) Comatose (GCS 3-8)


Mild Head injury. GCS 13 – 15 80%

Moderate Head injury GCS 9 – 12 10%

Severe Head injury GCS < 9 10%


GCS<13 at any point When to do CT- Scan
GCS 13-14 at 20
Focal deficit
- LoC or ante grade amnesia
+
? Open/depressed/Basal #
Age ≥ 65
Post-traumatic seizure
Coagulopathy/warfarin
> 1 vomiting episode
-
+ -
+ Get help!
Dangerous Mex:
pedestrian rta, ejection,
fall > 1m / 5stairs.
CT within 1hr Retrograde
amnesia>30mins

+ -
CT within 8hrs No imaging now
P Deep cuts or tears to the scalp
R Nausea
E Vomiting
S Severe headache
Visual disturbance
E Drowsiness or difficulty being aroused
N Unequal sized pupils, or pupils that do not
T respond to light
A Paralysis, numbness or loss of function over
T one half of the body
I Problems with balance
Fluid flowing from eyes and/or mouth
O Drunken behaviour
N Fits, confusion or unconsciousness
I
N
C
R Intense headache, worse when lying
flat and/or with physical exertion
E
Unequal or dilated pupils
A Vomiting
S
E Weakness on one side of the body
D Noisy, irregular breathing
Irritable or aggressive behaviour
I
C
P
I
N
C
R Sedate and intubate
E Nurse patient at 30 degree angle-aids
venous drainage
A
Mild hyperventilation- keep pCO2
S approx 4.5kPa- if allowed to fall lower
E this leads to vasoconstriction and
D subsequent ischaemia
Mild hypothermia
I
C
P
I
N
C
R Surgical management
E
A Burr holes
S Evacuation of mass lesion +/-
E craniectomy
D Decompressive craniectomy

I
C
P
THANKS

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