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

2. HEAD INJURY

4. 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

5. SIGNS OF A H.I.

6. CLOSED H.I.

7. MECHANISMS OF CLOSED H.I.

11. OPEN H.I.

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

13. B RAIN INFECTION (ABSCESS)

14. NORMAL & OEDAMATOUS BRAIN

15. I.C.H.

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

17. CT-SCAN MACHINE

18. MRI MACHINE

19. 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

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

21. Level of consciousness Glascow coma scale

22. COMMENTSCORE ASSESSMENT AREA Best possible score is 15, worst possible is 3. 43214321 Eye Opening (E ) - Spontaneous - To speech - To pain - None 654321654321 BEST Motor Response (M) - Obeys commands - Localizes pain - Normal flexion (withdrawal) - Abnormal flexion (decorticate) - Extension (decerebrate) - None (flaccid) 5432154321 Verbal Response (V) - Oriented - Confused conversation - Inappropriate words - Incomprehensible sounds - None Glasgow Coma Scale

23. MANAGEMENT ACCORDING TO SEVERITY

24. UNEQUAL SIZED PUPILS

25.  2-Nursing care  A-Airway  B-Management of restless patient  C-Sphinctor care  D-Skin care  E-Feeding  F-Antibiotics

26. AIRWAY PIECES

27. ENDOTRACHEAL TUBE

28. ENDOTRACHEAL INTUBATION

29. INTUBATED SEVERELY H.I. PATIENT

30. TRACHEOSTOMY

31. TRACHEOSTOMY TUBE CARE

32. MECHANICAL VENTILATION

33. BED SORES (PRESSURE ULCERS)

34. TYPES OF NUTRITION

35. NG-TUBE

37. GASTROSTOMY TUBE

38.  3-Indications for surgery  A-Simple stiching  B-Open H.I. (Penetrating)  C-I.C.H.

39. SUTURED SCALP WOUND

40. SURGERY FOR A DEPRESSED SKULL FRACTURE (CRANIECTOMY)

41. SURGERY FOR AN ACUTE SDH (CRANIOTOMY)

42. THANK YOU