Head trauma Dr.Yasir Hamandi

Aim of lecture To have an overview about head trauma,classifications,types and the management of each type

objectives Classification catigories Clinical classification Mechanism of injury Management complications

Clinical classification of head injury classifiead into 5 catigories 1-skull fractures: may or may not involve damage to the underlying brain A-linear frac. B-depressed frac. C-basilar frac.

Linear fracture

Depressed fracture

Skull base fracture

2- focal inj.:defined as visible damage that is generally limited to a well circumscribed region; e.g contusions(coup &countercoup),SDH,EDH,S.A.H,ICH,IVH Occur in half of all pat. With severe brain inj., ,and 2/3 of brain inj.related death.

E.D.H

S.D.H

I.C.H

CONTUSSION

3-diffuse brain injury.:occur without macroscopic structural damage a-cerebral concussion(transient reversible neurological dysfunc. As a result of trauma ) b-diffuse axonal injury c-ischaemic/hypoxic neuronal damage

Difuse injury Occur in about 40% of pat. With severe brain injury. 1/3 of deaths Most prevelant cause of disability in survivors of TBI. May involve alterations in neural excitability, neurotransmission,long term receptor dysfunction Or may be secondary to brain swelling and ischaemic injury

4-penetrating injury

Blast injury

Clinical classification according to severity(G.C.S) 1-G.C.S(3-8) SEVERE 2-G.C.S(9-13)MODERATE 3-G.C.S(14-15) MILD

Mechanism of head injury 1- contact: require that the head strike an object or be struck regardless of whether the blow causes the head to move afterward.

a- local contact effect:- most of linear and depressed skull fracture,some basilar frac.,E.D.H,COUP Contusions. E.D.H caused due to contact fracture that either leading to tear meningeal vessels(in adults) or bleeding from frac. Bone in children.

S.D.H : associated contusion and brain laceration result from contact or acceleration effect or result from torn cortical vessels especially in trivial head trauma in old age patients

b-remote contact effect: vault skull frac. Away from the impact site ,to basilar skull fractures.

2-inertial(acceleration): called head motion because they result from violent head motion,regardless of whether the head moves because of a direct blow

MANAGEMENT Ensure patent airway,blood oxygenation adequate

Space occupying haematoma requires urgent evacuation Scalp lacerations anticonvalscents

EDH

SDH

DEPRESSED #

DELAYED EFFECTS OF HEAD INJURY 1.post traumatic epilepsy Early epilepsy (within 1 week from injury)

Occur in 5% of admitted patients with non-missile injury Frequent in the 1st 24 hours Focal seizures are as common as generalized Status epilepticus in 10%

Risk of early epilepsy is high in Children under 5 years Patient with post traumatic amnesia Patients with intracranial hematoma Patient with compound depressed #

Late epilepsy (after 1 week from injury) Occur in 5% of all patients admitted to hospital Usually in 1st year In some occur after 10 y from the injury Usually generalized but temporal lobe epilepsy (complex partial )occur in 20 %

Late epilepsy is prevalent in patient with Early epilepsy 25% Intracranial hematoma 35% Compound depressed # 17%

End