Head Injury

CAUSE

Brain anatomy and

function

1.
2.
3.
4.

Dura mater
Arachnoid
Venae sagittalis superiores cerebri
Sinus sagittalis superior and Falx cerebri

The mechanism of head

injury
1. Direct trauma (direct injury).
1.1 head injuries while at rest (static
head injury).
1.2 injuries caused as head motion
(dynamic head injury).
2. Injury indirectly (indirect injury).

Direct injury While the head is stationary

(Static head injury)

The shot is hit Pathological conditions that

occur locally . Or brain may cause a severe
concussion . If the object is to hit a high
speed.

Direct head injury while moving

(dynamic head injury)

As head speed to hit the

object is stationary or
moving . Injury to the brain
(coup lesion) , which are
frequently associated with
fractures of the skull . The
opposite side of the brain
where the object is . Subject
to tearing and bleeding with
(contracoup lesion).

coup
lesion

contracoup
lesion

2.Injury indirectly
(indirect injury). Fall
butt hit the ground,
his head slammed
down onto the neck
of the femur . The
rapid movement of
ships As a result,
support for the head
of the head facing
forward or facing
backward glance .
This is no wounds on
the scalp and skull.

Pathological
physiological image
1. Head injuries early (primary head
injury) as soon as the injury resulting
impact on organs different layers . 2.
Head Injury second phase (secondary
head injury) is a complication that
occurs after a head injury early stages.
The duration in minutes, hours or days .

1. Head injuries early (primary

head injury).

Cause harm
1. scalp (scalp)
2. cranial (skull)
3. cerebral (brain)

1. ( scalp )
1.1 ( scalp )

( contusion )
( abrasion )
( laceration )

( avulsion )

1.2 ( skull )

( linear skull
fracture )
( basilar skull
fracture )
( depressed skull fracture )

2 3

3.

3.1 Focal brain injury

Cerebral concusstion

Cerebral contusion ( )

Arachnoid Pia

3.2
( diffused
white matter injury )

( bilateral decerebration )

interval )

( lucid


3. 3 ( brain
laceration )

Arachnoid Pia

2.

( secondary head injury )

2.1

Skull

epidural hematoma

meningeal artery

Epidural hematoma

tend to enlarge rapidly

Epidural hematomas
skull
fracture

skull

 subdural hematoma

skull dura
"bridging veins"
dura
skull
cerebral cortex dura
skull fracture
3
acute
48

subacute

2 2

Duramater

 Subarachnoid hemorrhage
arachnoid mater
traumatic

non trauma subarachnoid

non trauma
hemorrhages

rupture aneurysm

2.

( secondary head injury )

2.2 ( cerebral edema )

Vasogenic edema

Cytotoxic edema

2.

( secondary head injury )

2.3
( increased intracranial pressure )

( ventricular fluid pressure )

15 200

75

2.

( secondary head injury )

2.4

( brain

displacement )

( space occupying
lesion )

(minor head injury)

: GCS 13-15
( moderate head
injury )
: GCS 9-12
( severe head
injury )
: GCS 3-8

Glasgow Coma Score

Response

Score

Eye opening

Openseyesonown

Totouchorloudvoice

Topain

None

Verbal response

Oriented

Confused

Inappropriate

Incomprehensible

None

Motor response

Followssimplecommands

Localizespain

Withdraws

Flexestopain

Extendstopain

Nomotorresponsetopain

Levels of consciousness
Level

Conscious
Confused
Delirious
Obtunded
Stuporous
Comatose

Normal

Description

Disoriented; impaired thinking and

responses
Disoriented; restlessness, hallucinations,
sometimes delusions
Decreased alertness; slowed psychomotor
responses
Sleep-like state (not unconscious); little/
no spontaneous activity
Cannot be aroused; no response to stimuli

symptoms of mild head

injury
raised, swollen
bruise
small, superficial cut in the scalp

headache

symptoms of moderate to severe

head injury

confusion
loss of consciousness

blurred vision
severe headache
vomiting
loss of short-term memory,

slurred speech
difficult walking
dizziness
weakness in one side or area of the
body
sweating

pale skin color

seizures
behavior changes

blood or clear fluid

draining from the ears
or nose

one pupil looks larger
than the other eye

deep cut or laceration

in the scalp

open wound in the

Prognosis

GCS < 5 60-80%

Fixed dilate pupil,
decerebrate
CTscan ,

Apolipoprotien Allele E4

CSF Lactate,pyruvate,LDH,SGOT,CPK,Myelin
base protien

1.

( Glasgow Outcome Scale )

( minor head injury )

2. ( moderate head
injury )

3. ( Severe head
injury ) 50
6
20
40
40

Indication for admission

Minor head injury

Focal neurodeficit
Post traumatic seizure
Skull fracture
10

Moderate head injury

Severe head injury


1.
craniotomy

ventricular drainage
2.


sedative muscle relaxant

Epidural hematoma
EDH >30 cc.
EDH <30cc. <1.5 cm.midline
shift <5mm.GCS>8 no focal neurodeficit
Serial CT scan
Subdural hematoma
SDH >10mm., midline shift >5mm.
SDH GCS < 9 ICPmonitoring
SDH GCS < 9, <10mm.,midline shift <5mm.
GCS 2,
Asymmetric or fix dilated pupils, ICP>20
mmHg

 Depressed skull fracture

:Open depressed skull fracture depressed >
the thickness of the cranium
:Open depressed skull
fracture with No clinical or radiographic evidence of
dural penetration,significant intracranial
hematoma,depression >1 cm.,frontal sinus
involvement,gross cosmetic deformity,wound
infection,pneumocephalus,gross wound contamination
:Closed depressed skull
fracture

Investigation
Imaging
Studies
Skull x-rays

CT scan of the head

Magnetic resonance imaging
MRI may be used later for
additional information about
a brain injury.
Other x-rays may be performed to

 Initial blood tests

blood alcohol level for any
patient who has an altered level
of consciousness
Coagulation abnormalities, a
prothrombin time (PT), partial
thromboplastin time (PTT), and a
platelet count
Bleeding time assessment may

Urgent Scan in adult if any

of
GCS <13 when first assessed

GCS<15 two hours after injury

Suspected open or depressed skull fracture
Signs of base of skull fracture**
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting
Coagulopathy + any amnesia or LOC
since injury

**Signs of basal skull fracture: 'panda' eyes, CSF leakage (ears or nose) or
Battle's sign (bruising behind the ear in cases of basal skull

8 hours after injury, a CT scan

is also recommended

if there is either

More than 30 minutes of amnesia of events before

impact
Or any amnesia or LOC since injury if
Aged 65 years
Coagulopathy or on warfarin
Dangerous mechanism of injury

RTA as pedestrian
RTA - ejected from car
Fall > 1m or >5 stairs