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Head Injuries. Head Anatomy. Head Anatomy. Scalp. S: Skin C: Connective Tissue A: The aponeurosis L: Loose areolar connective tissue P: The pericranium. Brain Anatomy. Cranial Nerves. I. Olfactory - Smell II. Optic - Vision

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Head Injuries

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Head injuries

Head Injuries

Head anatomy

Head Anatomy

Head anatomy1

Head Anatomy



S: Skin

C: Connective Tissue

A: The aponeurosis

L: Loose areolar connective tissue

P: The pericranium

Brain anatomy

Brain Anatomy

Cranial nerves

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

Head injuries1

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

Head injuries2

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

Head injuries3

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

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Head Injuries

  • Concussion Assessments

    • Neurological Exam:

      • Cognitive function

      • Cranial Nerve testing

      • Coordination and Motor Function

      • Sensory Testing

      • Reflex Testing

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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

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Head Injuries

  • Concussion Assessments

    • Balance Tests

      • Romberg Test

      • Balance Error Scoring System (BESS)

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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

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Head Injuries

  • Concussion Assessments

    • Standardized Assessment of Concussion (SAC)

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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 E-mailed 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

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Head Injuries

  • Home Care for Concussion

    • It is OK to:

      • Use Acetaminophen (Tylenol)

      • Use Ice packs

      • Eat a light diet

      • Sleep

      • Rest

Head injuries11

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 15-20 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%

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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

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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

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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

Head injuries15

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

Head injuries16

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)

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Head Injuries

  • Scalp Injuries

    • MOI: usually blunt or penetrating trauma

    • Sx: extensive bleeding

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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

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