NEUROSURGERY LECTURES Prof. Dr. Ali Al-Shalchy M.B.CH.B F.IC.S M.R.C.S F.R.C.S

HEAD INJURY

CLASSIFICATION OF HEAD INJURY (H.I.)  1- Blunt injury  A-Acceleration injury  B-Decceleration injury  C-Acceleration-Decceleration injury D-Rotational injury 2-Penetrating injury

SIGNS OF A H.I.

CLOSED H.I.

MECHANISMS OF CLOSED H.I.

OPEN H.I.

DAMAGE CAUSED BY H.I.  1-Primary  2-Secondary  A-Infection  B-Brain oedema  C-Intracranial hemmorhage (I.C.H.)

B RAIN INFECTION (ABSCESS)

NORMAL & OEDAMATOUS BRAIN

I.C.H.

MANAGEMENT Of H.I.  Investigations  1-Skull X-ray  2-CT-Scan  3-MRI  4-Angiography, EEG

CT-SCAN MACHINE

MRI MACHINE

MANAGEMENT OF NON COMPLICATED H.I.  -Indications for admission of a  patient with H.I. :  1.loss of consciousness  2.skull fracture(s)  3.neurological deficit  4.medical diseases  5.convulsion following head injury  6.persistant headache and vomiting  7.doubtful cases

Line of management runs in three lines 1-Observation A-Level of consciousness B-Pupil C-Vital signs D-CNS signs (focal signs)

Level of consciousness Glascow coma scale

COMMENTSCORE ASSESSMENT AREA Best possible score is 15, worst possible is Eye Opening (E ) - Spontaneous - To speech - To pain - None BEST Motor Response (M) - Obeys commands - Localizes pain - Normal flexion (withdrawal) - Abnormal flexion (decorticate) - Extension (decerebrate) - None (flaccid) Verbal Response (V) - Oriented - Confused conversation - Inappropriate words - Incomprehensible sounds - None Glasgow Coma Scale

MANAGEMENT ACCORDING TO SEVERITY

UNEQUAL SIZED PUPILS

 2-Nursing care  A-Airway  B-Management of restless patient  C-Sphinctor care  D-Skin care  E-Feeding  F-Antibiotics

AIRWAY PIECES

ENDOTRACHEAL TUBE

ENDOTRACHEAL INTUBATION

INTUBATED SEVERELY H.I. PATIENT

TRACHEOSTOMY

TRACHEOSTOMY TUBE CARE

MECHANICAL VENTILATION

BED SORES (PRESSURE ULCERS)

TYPES OF NUTRITION

NG-TUBE

GASTROSTOMY TUBE

 3-Indications for surgery  A-Simple stiching  B-Open H.I. (Penetrating)  C-I.C.H.

SUTURED SCALP WOUND

SURGERY FOR A DEPRESSED SKULL FRACTURE (CRANIECTOMY)

SURGERY FOR AN ACUTE SDH (CRANIOTOMY)

THANK YOU