Head Injury. Dr Malith Kumarasinghe MBBS (Colombo). Head Injuries:. Account for about one half of all trauma deaths Survivors range from baseline function to severe morbidity Even “minor” head injury can have severe impact As with most trauma, broken down into blunt and penetrating.
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Dr Malith Kumarasinghe
- It usually resolves spontaneously.
- Vitamin K 1 mg IM is given.
2-Extradural ,subdural & subarachinoid.
3-Cerebral contusion& intraventricular Hge.
4-Diffuse Axonal Injury (DAI).
5-Related Brain edema & herniation.
Involve a break in the bone but no displacement, and generally no intervention is required.
These fractures are usually the result of low-energy transfer due to blunt trauma over a wide surface area of the skull.
The fracture involves the entire thickness of the skull.
Generally, these fractures are of little clinical significance unless they involve a vascular channel, a venous sinus groove, or a suture.
Complications include epidural hematoma, venous sinus thrombosis, and suture diastasis.
A fracture is clinically significant and requires elevation when a fragment of bone is depressed deeper than the adjacent inner table.
Depressed fractures may be closed or compound (open).
Compound fractures may be exposed when they are associated with a skin laceration or when the fracture extends into the paranasal sinuses and the middle-ear structures.
Diastatic fractures occur along the suture lines and usually affect newborns and infants in whom suture fusion has not yet happened. In this type of fracture, the normal suture lines are widened
Basilar fractures are the most serious and involve a linear break in the bone at the base of the skull.
Most basilar fractures occur at 2 specific anatomic locations—namely, the temporal region and the occipital condylar region.
These fractures are often associated with dural tears, of which cerebrospinal fluid (CSF) rhinorrhea and otorrhea are known complications.
Acute, subacute & chronic
In children, subdural hematomas occurring along the posterior interhemispheric fissure and the tentorium have been described as common findings following violent nonaccidentalshaking
Clinical presentation depends on the location of the lesion and the rate at which it develops.
Often, patients are rendered comatose at the time of the injury.
A subset of patients remain conscious; others deteriorate in a delayed fashion as the hematoma expands.
significant acute traumatic subdural hematoma requires surgical treatment, temporizing medical maneuvers can be preoperatively used to decrease intracranial pressure. These measures are germane for any acute mass lesion
As with any trauma patient, resuscitation begins with the ABCs
Short-acting sedatives and paralytics should be used only when needed to facilitate adequate ventilation or when elevated intracranial pressure is suspected.
The patient should also be mildly hyperventilated
Administer anticonvulsants to prevent seizure-induced ischemia and subsequent surges in intracranial pressure.
Do not give steroids, as they have been found to be ineffective in patients with head injury.
- Effaced sulci .
Subarachnoid hemorrhage (SAH) is classified according to 5 grades, as follows:
When traumatic, subarachnoid hemorrhage occurs most commonly over the cerebral convexities or adjacent to otherwise injured brain (i.e. adjacent to a cerebral contusion)
Craniotomy(cutting a hole in the skull) and aneurysm clipping -- to close the aneurysm
Endovascular coiling -- placing coils in the aneurysm to reduce the risk of further bleeding
On CT, cerebral contusion appears as an ill-defined hypodense area mixed with foci of hemorrhage. Adjacent subarachnoid hemorrhage is common. After 24-48 hours, hemorrhagic transformation or coalescence of petechial hemorrhages into a rounded hematoma is common
The true extent of axonal injury typically is worse than that visualized using current imaging techniques The CT of a patient with diffuse axonal injury may be normal despite the patient's presentation with a profound neurological deficit .
Stage I -This involves the parasagittal regions of the frontal lobes, the periventricular temporal lobes, and, less likely, the parietal and occipital lobes, internal and external capsules, and cerebellum.
Stage II - Thisinvolves the corpus callosum in addition to the white-matter areasof stage I.Most commonly, the posterior body and splenium are involved; however, the process is believed to advance anteriorly with increasing severity of disease. Both sides of the corpus callosum may be involved; however, involvement more frequently is unilateral and may be hemorrhagic. The involvement of the corpus callosum carries a poorer prognosis
Stage III - This involves the areas associated with stage II, with the addition of brainstem involvement. A predilection exists for the superior cerebellar peduncles, medial lemnisci, and corticospinal tracts .