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Central Nervous System Trauma

Central Nervous System Trauma. Estrada Bernard, MD Division of Neurosurgery UNC Chapel. Central Nervous System Trauma. U.S fatalities >150,000/yr SCI >10,000/yr Disabled (prev) >200,000. Central Nervous System Trauma –Incidence (San Diego). Central Nervous System Trauma.

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Central Nervous System Trauma

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  1. Central Nervous System Trauma Estrada Bernard, MD Division of Neurosurgery UNC Chapel

  2. Central Nervous System Trauma • U.S fatalities >150,000/yr • SCI >10,000/yr • Disabled (prev) >200,000

  3. Central Nervous System Trauma –Incidence (San Diego)

  4. Central Nervous System Trauma • Assume spinal injury • Maintain alignment • Watch for spinal shock

  5. Head Injury • Primary • Secondary

  6. Secondary Head Injury • Elevated ICP • Hypotension • Hypoxemia/Hypercapnia • Ischemia • Seizures

  7. Central Nervous System Trauma – Acute Evaluation • Primary survey (ABC) • Initial neurological exam • Post resuscitation exam

  8. Central Nervous System Trauma – Airway Mgmt • Avoid hypoxia • Avoid hypercarbia • Avoid aspiration

  9. Central Nervous System Trauma - Resuscitation • Goals • BP > 90 mm Hg • PaO2 > 60 mm Hg

  10. Central Nervous System Trauma – Acute Mgmt • ??? Sedation • ??? Neuromuscular blockade • ??? Mannitol • ??? Hyperventilation

  11. Cranial Nerve Injury Olfactory Optic Abducens Facial Vestibulocochlear

  12. Central Nervous System Trauma - Pathophysiology • Mediators • Mechanical • Neuroexcitation • Free radical production

  13. Skull Fractures • Types • Risk factors

  14. Skull Fractures • Linear • 62% of severe HI • Depressed • Simple • Compound • Basilar • csf fistula

  15. Head Injury Mechanisms Contact • Skull deformation • Local - skull fx, EDH, coup • Remote - vault, basilar fxs • Shock wave • Contrecoup • ICH

  16. Head Injury Mechanisms Acceleration • Surface strain • SDH • Contrecoup • Deep strain • Concussion • Dai

  17. Focal Injury • Hematoma • Extradural • Subdural • Intracerebral • Contusions • Coup • Contrecoup

  18. Diffuse Injury • Concussion • Diffuse axonal injury • Mild • Moderate • Severe

  19. Central Nervous System Trauma – Clinical Trials • Cholinergic agents • Corticosteroids • Barbiturates • Neuroexcitatory antagonists • Free radical scavengers • Calcium channel antagonists • Hypothermia

  20. Central Nervous System Trauma – Elevated ICP Rx • Progressive neurologic deterioration • Transtentorial herniation

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