1. Head Injuries

2. Head Anatomy

3. Head Anatomy

4. Scalp S: Skin C: Connective Tissue A: The aponeurosis
L: Loose areolar connective tissue
P: The pericranium

5. Brain Anatomy

6. Cranial Nerves I. Olfactory - Smell II. Optic - Vision
III. Oculomotor – Eye movement, opening of eyelid, constriction of pupil, focusing
IV. Trochlear – Inferior and lateral eye movement
V. Trigeminal – Sensation to face, mastication
VI. Abducens – Lateral movement of eye
VII. Facial – Facial expression, taste, control of tear, nasal, sublingual salivary, and submaxillary glands
VIII. Vestibulocochlear (Auditory) – Hearing and equilibrium
IX. Glossopharyngeal – Swallowing, salivation, gag reflex, tongue and ear sensation
X. Vagus – Swallowing, speech, regulation of pulmonary, GI, and cardiovascular functions
XI. Spinal Accessory – Swallowing, trapezius, SCM
XII. Hypoglossal – Tongue movement, speech, swallowing

7. Head Injuries Skull Fx MOI: Blunt trauma
Sx: Severe headache, nausea, skull indentation, may be blood in the middle ear, blood in the ear canal, blood through the nose, ecchymosis around the eyes (“raccoon eyes”), ecchymosis behind the ear (“Battle’s Sign”), Cerebrospinal fluid may appear in the ear canal and nose
Complications arise from intracranial bleeding, bone fragments in the brain, and infection

8. Head Injuries Concussion
Immediate and transient posttraumatic impairment of neural functions (ex: alterations of consciousness, vision disturbances, loss of equilibrium, etc.) due to brain stem involvement
Coup: injury occurs under the site of impact with an object
Contrecoup: injury occurs on the side opposite the area that was impacted

9. Head Injuries Concussion Sx: Confusion
Amnesia (Anterograde, Retrograde)
Headache
Dizziness
Ringing in the ears
Nausea or vomiting
Slurred speech
Fatigue
Memory or concentration problems
Sensitivity to light and noise
Sleep disturbances
Irritability
Depression
Listlessness, tiring easily
Irritability, crankiness
Change in eating or sleeping patterns
Loss of balance, unsteady walking

10. Head Injuries Concussion Assessments Neurological Exam:
Cognitive function
Cranial Nerve testing
Coordination and Motor Function
Sensory Testing
Reflex Testing

11. Head Injuries Concussion Assessments Eye Function PEARL Blurred Vision
Smooth tracking
Nystagmus – constant involuntary back and forth, up and down, or rotary movement of the eye

12. Head Injuries Concussion Assessments Balance Tests Romberg Test
Balance Error Scoring System (BESS)

13. Head Injuries Concussion Assessments Coordination Tests
Finger-to-nose
Heel-to-toe walking
Indicate injury to the cerebellum
Cognitive Tests
Serial 7’s (count down from 100 by 7)
Spelling a word backwards
Listing the months of the year in reverse order
Test recent memory

14. Head Injuries Concussion Assessments
Standardized Assessment of Concussion (SAC)

15. Head Injuries Concussion Assessments ImPACT
Immediate Post-Concussion Assessment and Cognitive Testing
Measures player symptoms
Computer administered
Can be administered on a lap-top for easy access and administration
Assists physicians and athletic trainers in making difficult return-to-play decisions
Permits individual and group administration
Provides reliable baseline test information
Results can be ed or Faxed for fast consultation by a Neuropsychologist
Produces comprehensive report of test results
Automatically stores data from repeat testing
Measures attention, memory, processing speed and reaction time
Reaction time measured to 1/100th of second

16. Head Injuries Home Care for Concussion It is OK to:
Use Acetaminophen (Tylenol)
Use Ice packs
Eat a light diet
Sleep
Rest

17. Head Injuries Second Impact Syndrome
Occurs because of rapid swelling and herniation of the brain after a second head injury that occurs before the previous injury has healed
Sx: Stunned look, within minutes the athlete’s conditions worsens with dilated pupils, loss of eye movement, loss if consciousness leading to coma, and respiratory failure
Mortality rate is approximately 50%

18. Head Injuries Cerebral Contusion
Small hemorrhages of intracranial bleeding within either the cortex, brain stem, or cerebellum usually resulting from an impact force where the head strikes a stationary object
Sx: LOC but then becomes very alert and talkative. Normal neurological exam, headache, dizziness, nausea
Hospitalization and CT Scan or MRI

19. Head Injuries Malignant Brain Edema Syndrome Young athletes
In adults, this syndrome occurs due to intracranial clots
Diffuse brain swelling resulting from hyperemia (blood congests in a particular area of the body) or vascular engorgement with little or no injury to the brain
Life-threatening consequences occur due to raised intracranial pressure with herniation
Sx: Alert state to coma and occasionally death in minutes-hours

20. Head Injuries Epidural Hematoma
Blow to the head that can cause a tear of the meningeal arteries
Occurs extremely quickly
Sx: LOC (most cases), severe head pain, dizziness, nausea, dilation of one pupil, sleepiness
Later stages: deteriorating consciousness, neck stiffness, slower pulse and respiration, convulsions
Life-threatening
Surgically relieved

21. Head Injuries Subdural Hematoma
Occurs more frequently than epidural hematomas and are the most common cause of death in athletes
MOI: Acceleration/deceleration forces that tear vessels that bridge the dura mater and the brain
3 Kinds:
Acute: Arterial bleeding
Associated with other brain and skull injuries
Chronic: Venous bleeding
Sx: Not likely to be unconscious, dilation of one pupil, headache, dizziness, nausea, sleepiness

22. Head Injuries Migraine Headaches
Last anywhere from 4 hours to as long as 72 hours
More common in women
Falling estrogen levels just before menstruation can cause a mnigraine
Sx: throbbing/pulsating, may be located on one side of the head, person only wants to lie down in a dark room and sleep, nausea, vomiting, sensitivity to light, smell, or sound, visual changes (bright flashing lights, colored zigzag lines, blind spots, loss of vision on one side), tingling or numbness in arms or legs
Precipitating factors:
Premenstrual, menstrual, oral contraceptive pills, pregnancy, puberty, menopause, hyperthyroidism, fever, anemia, rhinitis, changes in temperature or altitude, change in activity, alcohol especially red wine, chocolates, cheese, nuts, hot dogs, drugs (nitroglycerin, nitrates, indomethacin), blood pressure changes, sleep (too much, too little)

23. Head Injuries Scalp Injuries MOI: usually blunt or penetrating trauma
Sx: extensive bleeding

24. Head Injuries Stroke Lack of oxygen to the brain
Often caused by interrupted blood flow from a clot or aneurism causing the blood vessels to burst
Can cause a coma, paralysis, speech problems, dementia
Sx: numbness or weakness is face, arm, or leg (especially on one side of the body), confusion, trouble speaking or understanding, vision differences in one or both eyes, slurred speech, trouble walking, dizziness, loss of balance and coordination, sever headache

25. Questions / Comments?