head injury ppt

Head Injury

Dr.saad farhan al masoudi

Is the most common cause of mortality and morbidity . Commonly affect healthy children and active young adults . Is a major public health problem . Is largely preventable .
* Causes : RTA 50% FFH Assault Sports Industrial accident
*prevention : Is the most effective means of improving survival rates . Little can be done as a treatment , improving safety devices in cars .safety laws : seat belts , helmets , …….est public education . *

Classification of Head injury

1. skull fracture with or without brain injury vault fracture base fracture2. Focal brain injury which includes a.Brain contusion which define as abruises of neural parenchyma , always traumatic , wedge in shape , involve cortex surface associate with intact pial – glial membrane and these contusion subdivided toCoup ------ below site of impaction Contre coup ------ remote from site of impaed Intermediate ------ within brain parenchyma between site of impaction and opposite side of brain .b. Hemorrhage / hematoma epidural subdural Intra cerebral petechial


3.Diffuse brain injury a.concussion :- a transient reversible neurological dysfunction due to trauma not sufficient to cause structural damage to bruin parenchyma . b.diffuse axonal injury : structural damage to brain leading to prolong coma not cansed by mass effect , its severity depend on duration of acceleration magnitude of injury rate of acceleration direction of acceleration .

Mechanisms of Head trauma 

A. Contact injury : slow , focal brain injury this require that head strikes an object or is struck , regard less of whether the blow causes the head to move after ward . and include . 1. Local contact injury (effects ) examples , linear skull fracture depressed skull fracture s.t. fracture base of skull epidural hematoma coup contusion 2. remote contact injury ( effects) :example vault fraeture fracture base of skull contre coup contusion Intermediate coup contusion Intracerebral hemorrhage

B.Head motion ( inertial ) injury : inertial injury are often called head motion injury or acceleration injuries because the result from violent head motion , regardless of whether the head moves because of a direct blow or not . Inertial loading of head cause rapid movement of the head that resultant injury is due only to the manner in which the head moves . Head motion injuries termed acceleration injuries and these acceleration classified to transilation acceleration Rotational acceleration Angular acceleration(both transition) and rotation type , combine to gather )


Head motion injuries classified to :1.skull – brain relative motion subdural hemtoma contra coup contusion intermediate coup contusion2.Brain Deformation Concussion syndrome Diffuse axonal injuryIntracerebral hemorrhageTissue tear hemorrhage

pathophysiology of traumatic brain injury 

1. Ischemia which caused by ↑ ICP Local destructions by space occupying lesion .Severe vasoconstriction caused by release of K+ from ICC to ECC . 2. Hypoxia due to Respiratory dysfunction Inadequate ventilation Problems in O2 delivery 3. Acidosis : which a consequence of ischemia and hypoxic leading to lactic acid acidosis that affect protein synthesis and function →cell membrane neuronal damage .4. free radicle formation : ( H2O2 ) which occur from reperfusion after trauma → neural damage 5. ↑ neurotransmitter → release secondary to ischemia like glutamate → neurotoxicity .

Systemic manifestation of traumatic brain injury 

1. Abnormality of water and electrolyte homeostasis *Hyper natremia diabetes insipidns poor fluid intake . *hypo natremia SIADH with ↑ blood volumeCerebral salt wasting syndrome same as SIADH but with decrease in blood volume 2. hormonal abnormalities ( hypo and hyper secretion of anterior pituitary hormones ) , increase catacholamine production .3. Metabolic change , ( hyper metabolic state , depressed cellular immunity 4. cardio pulmonary malfunction cardiac subendocardial hemorrhage cardiac arrhythmia heart failure pulmonary - neurogenic pulmonary edema ( few minute ) delayed pulmonary dysfunction 24 – 48 hr

pathology of closed head injury

1. soft tissue injuries of head and neck periorbital ecchymoses ( Raccoon eye ) postauricular ecchymoses ( battle's sign ) scalp ( abrasion , laceration , contusions ) facial injury peripheral cranial nerve retinal hemorrhage.

2. skull fracture :linear #: most common type seen in severe head injury cause by out bending of bone at a distance from impact side as a result of general deformation of skull . depressed # : can be define when the outer table of depressed segment of bone below the inner table of the non – depressed segment . comminuted # : multiple linear # .diastatic # : are linear fractures along sutures line resulting in separation of cranial sutures .


3. Brain injuries : A . primary brain injuries include. 1. Focal injuries : *Hematoma which are - intracerebral H. -extradural H. -subdural H. -subarachoid H.( most common ) *Contusion / lacerations of . - brain tissue - brain stem - cranial nerve - blood vessels - pituitary gland and -hypothalamus . 2. Diffuse injuries : -Concussion -Diffuse axonal injuries .

B. secondary brain injuries due to : 1. Ischemia of brain tissue neural tissues caused by ↑Icp and herniation Mass effect K + extracellular release and vasoconstrictor 2. hypoxia dne to :Hypotension Hypoventilation Respiration dysfunction Inadequate O2 deliver to tissues .

Evaluation of patient with head trauma

A . General evaluation : which include 1. head and neck , site of trauma 2. other part of body like chest , abdomen , extremities . 3. vital signs , BP , PR , RR 4. reason behind head trauma .


B. neurological evaluation : which include 1. Glasgow coma scale ( GCS ) for state and level of consciousness. 2. pupils and cranial nerve examinations Pupillary light reflex , dolls eye( oculocephalic reflex ) , swallowing and vocal cord function . 3. motor responses : movement type , weakness , posture whether flexor or extensor . 4. sensory responses : painful stimuli commonly include nail bed pressure or nipple pinching lead to patient arousal .


5. Reflexes : Brain stem reflexesCranial nerve reflexesMuscle stretch reflexes 6. Respiration :Cheyne – stokes breathing →cortical lesion Uniform hyperventilation → pontine lesion Irregular , ataxic breathing → medullar lesion 7. Brain death examination : Apnea test Brain stem reflexes EEG ( electroencephalography ) Angiography 8. Glasgow out come scale 5 → good recovery 4 → moderate disability , independent 3 → severe disability , conscious , dependent 2 → persistent vegetative state 1 → Death

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