2. Sports Medicine HEAD Injuries CHAPTER 22

3. Vocabulary:  Encephalon  Meninges  Cerebrospinal fluid  Automatism  Posttraumatic amnesia  Retrograde amnesia  Intracranial hemorrhage  Tinnitus  Rhomberg’s sign  Cerebral hyperemia  Cerebral edema  Occlusion  Malocclusion  Epistaxis  Cauterization  hyphemia  Hematoma auris  Nystagmus  Keloid  Photophobia  External Otitis  Orbital Hematoma

4. ANATOMY--  HEAD-bones of skull  scalp is the first line of defense  Bones of the skull makes up the second line of defense for the brain  28 bones in the skull  Frontal, temporal, parietal, occipital  MENINGES- skull matter  Protective coverings that enclose the spinal cord and the brain. Their primary functions are to channel forces away from the vital structures and provide a passage way for blood vessels, lymphatic vessels and nerves

5. The meninges  Dura mater –Superficial lines against the skull. It is the toughest and contains blood vessels and nerves  Arachnoid mater –Netlike structure, forming a web over the brain  Pia mater –Deepest and follows all the irregular contours of the brain

6. MECHANISM OF INJURY  Direct blow- –thin bone produces local trauma in bending/tensile stress inner table –Thick bone non trauma local in bending/tensile stress with peripheral out bending/tensile stress with peripheral out bending outer table –Size of impact smaller more serious than large surface area

7. MECHANISM OF INJURY  Coup injury- a forceful blow to the resting moveable head usually produces maximal brain injury beneath the point of cranial impact  Contra coup injury- when a moving head collides with a nonmoving object producing maximal brain injury to the opposite site of cranial impact

8. Injuries to the Head  Subdural Hematoma –Involves veins in the brain. – Usually tear the bridge between the dura mater to the brain. –Contra coup type of an injury. –Hemorrhage is slow and should be watched very closely for 24 hours  Epidural hematoma –Common with a temporal skull fx. –Artery- rapid bleeding –Brief period of unconsciousness followed by consciousness to coma to death within a period of 15- 30 min.

9. Injuries to the Head  Intracerebral bleeding –Bleeding within the brain itself –Deterioration of neurological function occurs rapidly  Skull fractures –Severe blow to head –Difficult to determine even by x-ray –Watch for intracranial bleeding signs

10. Concussions

11. Definition of Concussion  Any alteration in cerebral function caused by a direct or indirect (rotational) force transmitted to the head resulting in one of the following acute signs or symptoms: –Brief loss of consciousness –Light-headedness –Vertigo (dizziness) –Cognitive or memory dysfunction

12. Signs/symptoms cont. concussion  Tinnitus (ringing in the ears)  Blurred vision  Difficult concentrating  Amnesia  Headache  Nausea and vomiting  Photo-phobia  Balance disturbance

13. Signs/symptoms cont. concussion  Delayed Signs and Symptoms:  Sleep irregularities  Fatigue  Inability to perform usual daily activities  Depression  Lethargy

14. Facial Injuries  Jaw fracture:  Second to all facial fractures  Most common fx near jaws frontal angle  Deformity or malocclusion  Pain when biting down  Bleeding around teeth  Lower lip numbness  Cheekbone fx. (zygomatic)  Around the eye, 3 rd most common facial injury  Loss of vision

15. Facial Injuries  Teeth injuries  If dislocated: replace in socket  Enamel is the hardest substance within the body  Fractured nose:  Most common fx. To the face  RX: control bleeding- x-ray –Have athlete sit upright –Cold compress –Direct pressure to nostril  Cauliflower ear: hematoma auris  Cold compress  Possible drain and cast  Wear protective ear covering

16. Eye injuries  Symptoms indicating serious eye injury:  Blurred vision not clearing with blinking  Loss of all or part of the visual field  Pain that is sharp, stabbing, or throbbing  Double vision  RX: cover both eyes but put no pressure on the eye  Transport to hospital

17. Eye injuries  Blowout fracture  Hemorrhage occurs around the inferior aspect margins of the eye  Diplopia  Pain while moving eye  Retinal detachment  More common with myopia (nearsightedness)  Seeing specks floating before the eye  Flashes of light  Blurred vision  Curtain falling over the field of vision