د.عبدالرحمن

HEAD INJURIES

Coup and Countercoup

Coup and Countercoup

“The Glasgow Coma Score”

Scalp LacerationGun Shot

Scalp Laceration + Cellulitis

Management of Scalp laceration (wounds of the scalp)

Plain X-ray is performed. Shaving widely around the wound. Closure in 2 layers

Scalp Lacerations

Subgaleal Haematoma

Subgaleal Haematoma

Subgaleal Haematoma

Subgaleal Haematoma

Subgaleal Haematoma

Management of Scalp Haematoma (Subgaleal Haematoma)

Leave the lesion alone. It should not be tapped. Correction of anaemia in children less than 1 year of age.

Skull Fractures Classification

a. Simple linear fractures:
May be closed or opened. Require no specific neurosurgical management. Result of blunt trauma. Usually require computed tomography (CT) Patient should be admitted for 48 hours of observation. Fractures crossing the squamous temporal bone may lacerate middle meningeal vessels and cause extradural haematoma.

Linear Skull Fracture

Linear Skull Fracture

Linear Skull FractureBone Window

Linear Skull Fracture

Linear Skull Fracture

Linear Skull Fracture

Linear Skull Fracture

b. Depressed skull fractures

Usually result from sharper trauma. Depressed skull fractures may be: Closed depressed fractures Compound depressed fracture (opened)

Depressed Skull Fractures

Depressed Skull Fractures

Depressed Skull Fractures

Depressed Skull FracturesBone Window

Depressed Skull Fractures

Depressed Skull Fractures

Depressed Skull FracturesBone Window

Depressed Skull Fractures

Depressed Skull Fractures

Depressed Skull Fracturesfrontal Depressed Fracture

Depressed Skull Fracturesfrontal Depressed Fracture

Depressed Skull Fracturesfrontal Depressed Fracture

Depressed Skull Fracturesfrontal Depressed Fracture

Depressed Skull Fracturesfrontal Depressed Fracture

Closed depressed fractures
Rare in adults The depressed segment rarely causes cerebral compression Plain X-ray will visualize the depressed segment. Treatment : usually conservative measures

Indications for surgery to raise the closed depressed fracture

Large depressed segment with possibility of dural tear. Alleviate mass effect. Cosmetic purposes. To prevent secondary infection.

Compound depressed fracture

Cause profuse bleeding, leakage of CSF and prolapse of a portion of the brain. Concussion is slight and there is usually no compression. The main hazard here is the liability to infection.

Treatment of compound depressed fracture

Foreign bodies are meticulously removed. The depressed segment is gently elevated to avoid tearing of the dura. Any prolapsed or necrotic tissue is sucked and haemostasis is performed. Any dural tear is repaired. Removed bone segments are cleaned and replaced. The pericranium and the scalp are sutured. Prophylactic antibiotics are administered.

Complications of depressed fractures

Dural tear leading to prolapse of the brain. Infection; may lead to osteomyelitis or meningitis. Epilepsy: either early or late. Cosmetic deformity. Sever bleeding from one of the venous sinuses.

c. Diastatic fractures

It is separation of a cranial suture line. It involves the coronal or lambdoid suture. Diastatic fractures are common in infants under 3 years old and rare in older age groups except as part of a more extensive skull fracture.

Diastatic Fractures

Diastatic Fractures

Diastatic Fractures

Diastatic Fractures



d. Pond (ping pong fractures)
This is a smooth concave depression due to blunt trauma to the cranial vault.Usually seen in children and also known as ‘ping-pong fracture’, as it looks similar to a dent in a ping-pong ball.Fracture will elevate spontaneously if less than 3cm in diameter.If the fracture is more than 5cm in diameter, it may need surgical elevation.

Ping Pong Fractures

The Raccoon

The Raccoon

The Raccoon

Anterior fossa basal fracturesRaccoon Eyes

Anterior fossa basal fracturesRaccoon Eyes



Anterior fossa basal fractures

Anterior fossa basal fractures

b. Middle fossa basal fractures
Involve the pertrous temporal bone. Clinical presentations: CSF Otorrhoea. Haemotympanum. Battle sign; discoloration over the mastoid process. VII and VIII cranial nerve palsies.

Battle sign

Middle fossa basal fractures

Middle fossa basal fractures

c. Posterior fossa basal fractures
1. Boggy swelling or discoloration at the neck due to extravasations of blood in the suboccipital region. 2. Injury to cranial nerves: usually involve 9th, 10th, and 11th cranial nerves at the jugular foramen. 3. Retraction of the head and stiffness of the cervical muscles due to upper cervical nerves irritation.

Posterior fossa basal fractures

Skull Base Fractures

Management of skull base fractures

1. Prevention of infection: prophylactic antibiotics. 2. Control of CSF leakage: conservative or surgical intervention. 3. Treatment of associated brain injury.