1. Head injuries

2. Definition Head injury is an injury to the scalp, skull, or brain.
The most important consequence of head injery is traumatic brain injury.
Head injury may occur either as a closed head injury, such as the head hitting a car or as a penetrating head injury, as when a bullet pierces the skull. Both may cause damage that ranges from mild to severe .
Very severe injury can be fatal because of profound brain damage.

3. Possible injuries to Brain
Cerebral Contusion
Is the commonest form of traumatic intra-axial injury.
Contusions occur at the inferior
and polar surfaces of the frontal and temporal lobes.
Cerebral contusions are also produced secondary to depressed skull fractures and are associated with other intracranial injuries

4. Clinical features
Brain injury may be generalized with widespread brain damage ( In this case an increase in the vascular permeability will occur resulting in cerebral edema
decreased respiratory exchange in severely injured patients also leads to anoxia resulting in cerebral vasodilatation which lead to cerebral swelling
Usually associated with a brief loss of consciousness.
The elderly patients, alcoholics and patients taking anticoagulants are at increased risk of hemorrhage

5. Radiological features
Non-contrast computed tomography (CT) useful in the early posttraumatic period.
Contusions are seen as multiple focal areas of low or mixed attenuation intermixed with tiny areas of increased density representing hemorrhage.
True extent becomes apparent over time with progression of cell necrosis and edema.
Magnetic resonance imaging (MRI) is the best modality for demonstration of edema and contusion distribution.
Cerebral contusions in both frontal lobes (arrows). The adjacent low density represents local edema.

6. Skull fractures
Skull fractures are more serious than other bones fractures if the brain is injured
These fractures can be classified into :-
Closed if the overlying skin is intact OR
Compound if the overlying skin is affected
Linear if there is a single fracture line
Stellate if there is several fracture lines radiating from a central point
Depressed or not depressed according to the movement of the fracture edges below the level of surrounding bone

7. a))
(b)
Infra-orbital fracture. (a) ‘Teardrop’ sign. (b) Coronal CT demonstrating the same.

8. Simple Skull fractures
This may be linear- stellate or comminuted but not depressed
if they cross the major vascular channels epidural and subdural haematoma may occurs
the patient with this type of fractures should be kept under close observation until certain that no bleeding is occurring
)Simple vault fracture (arrowheads

9. Depressed Skull fractures
Depressed fractures affects the underlying brain cortex which may cause neurologic effects
Some time called ping-pong fractures
A tangential view may use to show the degree of depression if CT unavailable

10. Skull Base fractures
Are fractures through the dense inner structures of the temporal bone
the major signs includes rhinorrhea , otorrhea
this type of fractures is very difficult to demonstrate according to the complex anatomy through this area.
If bleeding occurs plain radiographs may revel air-fluid level in the sphenoid sinus ( lateral view)
the use of CT scan is more effective to demonstrate this type of fractures
skull base fracture

11. Gunshot wounds Scalp injuries
Gunshots can be visualized by plain film images which used to localize the bullets in gunshot victim ( the bullet is easily localized because of lead contents
Scalp injuries
Scalp is an extremely vascular structure , and injury may cause serious hemorrhage
All scalp wounds should be closed as soon as possible unless they overlying a depressed fracture or penetrating wound of the skull which need special care in the operating room
The common Scalp injury is laceration

12. investigations
Skull films are not indicated routinely for the following indications:
Headache
Possible pituitary problems - ( CT/MRI preferred)
Possible space occupying lesion
Epilepsy
Dementia or memory loss
Middle or inner ear problems
Temporal mandibular joint dysfunction - will not show disc abnormality which is the most common cause of dysfunction.

13. Subarachnoid haemorrhage Intracerebral hematoma

14. Large hypo dense area
Brain infarct

15. Epidural hematoma
Subdural hematoma

16. The end