Presentation on theme: "TRAUMA TO THE SCALP (LACERATIONS)"— Presentation transcript:
1TRAUMA TO THE SCALP (LACERATIONS) TRAUMA TO THE HEADTRAUMA TO THE SCALP (LACERATIONS)2.TRAUMA TO THE SCALP( FRACTURES)3.TRAUMA TO BRAINCONTUSIONSLACERATIONSHEMORRHAGEProf. C. E. Connolly
2SCALPBecause of tight appostion of the scalp to the calavrium – lacerations easily occurBleed copiously +++ Hard to stop. There is free communication between the vessels of the scalp and face to the veins of the meninges. Danger of Meningitis especially when the laceration is accompanied by a # of skull. There may be grave injury to the brain without skull # or scalp injury.
3Fractures of the Skull1. Localised Depressed Fracture: due to blunt force .ie. Hammer blow. Plank of wood etc.2. Linear Fracture due to R.T.A. Blunt force or a simple fall often to the Base of skull ( easy to miss on X Ray)NoteLook for bleeding from the ear(s) or into the orbit – Black Eyes- Hematuma of Eye - # Base of skull. Leak of C.S.F. from nose – Clear Fluid.
4Concussion/ Loss of Consciousness Injury Instantaneous loss of function of loss of consciousness followed by rapid (mins) and complete recovery.If consciousness lost the individual experiences no sensation until his sudden rather surprised awakening.Retrograde Amnesia- No memory of blow. Duration of loss of consciousness is a guide to the degree of cerebral pathology.Pathology Mild degrees of Diffuse Axonal Injury ( D.A.I.)
5Intracranial Hemorrhage 1. Extradural: Blood between Bone and(“Epidural”) Dura.2.Subdural: Blood between Dura and Brain.3. Subarachnoid: Blood beneath the Leptomeninges due to a ruptured Berry Aneurysm or Trauma – RTA or Blow to side fo the upper neck ( Karate Chop!)
6Extradural Clinical Trauma (Kick, Blow) to the side of the head Concussion – Rapid Recovery- Lucid interval- Loss of consciousness – coma- Death with 6-12 Hours or less!Path # of Temporal Bone (Fragile) with tearing of the middle meningeal artery/vein Slow bleeding with gradual separation of Dura from Bone over period of 6-12 Hours .Accumulation of a large HematomaOutside DuraCompression of Brain.
7SubduralClinical : Elderly Patient – Minor trauma (fall etc.) to head . Usually no Skull fracture. Presents a week or two later with C.N.S Deficit i.e. Memory loss, Blurred vision , Headache, EpilepseyPATHOLOGYTearing of Veins as they enter the Sup. Saggital Sinus due to the shearing force on veins coming from a small atrophic brain which is oscillating due to minor trauma Slow Venous Oozing into subdural space(200 – 500 mls)Granulation tissue grows into Hematoma from Dura.
8SubduralPath Hematoma becomes encapsulated by granulation tissue – thin capsule formed. Hematoma may increase in volume by1. Rebleeding from granulation tissue2. Hyerosmotic stateHematoma may draw in CSF fromsubarachnoid space below3. Further falls, trauma etc.
10Head Trauma - ChildrenChild’s skull bones are pliable. Unusual to see fractures. Usually see Ping-Pong Ball indentations ( “fractures”) in skull .Middle Meningeal Artery torn much less often.Separation of sutures often seen with violent trauma rather than a fracture.Tearing of Bridging veins from Cerebral Cortex to Sup. Saggital Sinus Acute Subdural Hematoma.I.C.P.
11Coup InjuriesWhen the stationary head is struck with a blunt instrument (i.e hammer) contusions are located beneath the point of impactContusion- Pinpoint Necrosis of Brain Tissue – rupture of tiny capillaries – Bleeding resolution over weeks –months – Tiny Brown concave depression.
12ContraCoup InjuriesWhen the moving head strikes a firm surface. i.e. (Footpath, Road, etc.) Brain contusions are located opposite the point of impact in the absence of a skull fractureFALL FALL
13Contra Coup ( Mechanism) Brain Lag:As the skull is accelerated towards the ground the brain will lag towards the anterior surface compared to the CSF insulation fluid which shifts immediately in the direction of CSFAcceleration sloshs to the back. Fails to insulate brain anteriorly – Damaged against underlying rough projection bone.
14Trauma to the Head 1. Blunt trauma due to blows to Head Laceration of ScalpFractures of SkullExtra-Dural Hematoma – Contusions of Brain2. Head-in-Motion InjuryFalls, RTA’s, Boxers, etc.Subdural Hematoma(No fractures) (Tearing of veins)AND/ORDiffuse Axonal Injury (D.A.I)(Shearing of Axons) (90% due to RTA’s)
15Acute Traumatic Subarchnoid Hemorrhage Cause: Trauma to the Verteral Artery with a Laceration. Artery is most vulnerable on the transverse process of C1 where it emerges from the foramina Bleeding under pressure into the subarachnoid space up. In the posterior fossa.Trauma may be due to1. Blow to the side of the behind the Ear (Karate Chop)2. Acute Rotational Movement to the Head
16Trauma to the Brain . II Children Commonest cause of Death in Children – Intracranial Hemeorrhage + Skull FractureSpecificallySubdural HematomaBlunt Impact ( Fist , Fall etc.)Cause Shaking Head (“Shaking Baby Syndrome”)Death due to Cerebral Edema ++++ Diffuse Axonal DamageSub Dural Haem. due to rupture ofvessels in subdural space.