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TRAUMA TO THE HEAD. TRAUMA TO THE SCALP (LACERATIONS) 2.TRAUMA TO THE SCALP ( FRACTURES) 3.TRAUMA TO BRAIN CONTUSIONS LACERATIONS HEMORRHAGE Prof. C. E. Connolly. SCALP.

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trauma to the head

TRAUMA TO THE HEAD

TRAUMA TO THE SCALP (LACERATIONS)

2.TRAUMA TO THE SCALP

( FRACTURES)

3.TRAUMA TO BRAIN

CONTUSIONS

LACERATIONS

HEMORRHAGE

Prof. C. E. Connolly

scalp
SCALP
  • Because of tight appostion of the scalp to the calavrium – lacerations easily occur
  • Bleed copiously +++ Hard to stop. There is free communication between the vessels of the scalp and face to the veins of the meninges.
  •  Danger of Meningitis especially when the laceration is accompanied by a # of skull. There may be grave injury to the brain without skull # or scalp injury.
fractures of the skull
Fractures of the Skull
  • 1. Localised Depressed Fracture: due to blunt force .ie. Hammer blow. Plank of wood etc.
  • 2. Linear Fracture due to R.T.A. Blunt force or a simple fall often to the Base of skull ( easy to miss on X Ray)
  • Note
  • Look for bleeding from the ear(s) or into the orbit – Black Eyes- Hematuma of Eye - # Base of skull. Leak of C.S.F. from nose – Clear Fluid.
concussion loss of consciousness injury
Concussion/ Loss of Consciousness Injury
  • Instantaneous loss of function of loss of consciousness followed by rapid (mins) and complete recovery.
  • If consciousness lost the individual experiences no sensation until his sudden rather surprised awakening.
  • Retrograde Amnesia- No memory of blow. Duration of loss of consciousness is a guide to the degree of cerebral pathology.
  • Pathology  Mild degrees of Diffuse Axonal Injury ( D.A.I.)
intracranial hemorrhage
Intracranial Hemorrhage
  • 1. Extradural: Blood between Bone and

(“Epidural”) Dura.

2.Subdural: Blood between Dura and Brain.

3. Subarachnoid: Blood beneath the Leptomeninges due to a ruptured Berry Aneurysm or Trauma – RTA or Blow to side fo the upper neck ( Karate Chop!)

extradural
Extradural
  • Clinical Trauma (Kick, Blow) to the side of the head
  • Concussion – Rapid Recovery- Lucid interval- Loss of consciousness – coma- Death with 6-12 Hours or less!
  • Path # of Temporal Bone (Fragile) with tearing of the middle meningeal artery/vein

 Slow bleeding with gradual separation of Dura from Bone over period of 6-12 Hours .

Accumulation of a large Hematoma

  • Outside Dura
  • Compression of Brain.
subdural
Subdural
  • Clinical : Elderly Patient – Minor trauma (fall etc.) to head . Usually no Skull fracture. Presents a week or two later with C.N.S Deficit i.e. Memory loss, Blurred vision , Headache, Epilepsey
  • PATHOLOGY
  • Tearing of Veins as they enter the Sup. Saggital Sinus due to the shearing force on veins coming from a small atrophic brain which is oscillating due to minor trauma
  •  Slow Venous Oozing into subdural space
  • (200 – 500 mls)
  • Granulation tissue grows into Hematoma from Dura.
subdural1
Subdural
  • Path Hematoma becomes encapsulated by granulation tissue – thin capsule formed. Hematoma may increase in volume by
  • 1. Rebleeding from granulation tissue
  • 2. Hyerosmotic state

Hematoma may draw in CSF from

subarachnoid space below

  • 3. Further falls, trauma etc.
head trauma children
Head Trauma - Children
  • Child’s skull bones are pliable. Unusual to see fractures. Usually see Ping-Pong Ball indentations ( “fractures”) in skull .
  • Middle Meningeal Artery torn much less often.
  • Separation of sutures often seen with violent trauma rather than a fracture.
  • Tearing of Bridging veins from Cerebral Cortex to Sup. Saggital Sinus  Acute Subdural Hematoma.

I.C.P. 

coup injuries
Coup Injuries
  • When the stationary head is struck with a blunt instrument (i.e hammer) contusions are located beneath the point of impact
  • Contusion- Pinpoint Necrosis of Brain Tissue – rupture of tiny capillaries – Bleeding resolution over weeks –months – Tiny Brown concave depression.
contracoup injuries
ContraCoup Injuries
  • When the moving head strikes a firm surface. i.e. (Footpath, Road, etc.) Brain contusions are located opposite the point of impact in the absence of a skull fracture

FALL  FALL

contra coup mechanism
Contra Coup ( Mechanism)
  • Brain Lag:
  • As the skull is accelerated towards the ground the brain will lag towards the anterior surface compared to the CSF insulation fluid which shifts immediately in the direction of CSF
  • Acceleration sloshs to the back. Fails to insulate brain anteriorly – Damaged against underlying rough projection bone.
trauma to the head1
Trauma to the Head
  • 1. Blunt trauma due to blows to Head
  • Laceration of Scalp
  • Fractures of Skull
  • Extra-Dural Hematoma – Contusions of Brain

2. Head-in-Motion Injury

Falls, RTA’s, Boxers, etc.

Subdural Hematoma

(No fractures) (Tearing of veins)

AND/OR

Diffuse Axonal Injury (D.A.I)

(Shearing of Axons) (90% due to RTA’s)

acute traumatic subarchnoid hemorrhage
Acute Traumatic Subarchnoid Hemorrhage
  • Cause: Trauma to the Verteral Artery with a Laceration. Artery is most vulnerable on the transverse process of C1 where it emerges from the foramina Bleeding under pressure into the subarachnoid space up. In the posterior fossa.
  • Trauma may be due to
  • 1. Blow to the side of the behind the Ear (Karate Chop)
  • 2. Acute Rotational Movement to the Head
trauma to the brain ii children
Trauma to the Brain . II Children
  • Commonest cause of Death in Children – Intracranial Hemeorrhage + Skull Fracture
  • Specifically
  • Subdural Hematoma

Blunt Impact ( Fist , Fall etc.)

  • Cause  Shaking Head (“Shaking Baby Syndrome”)
  • Death due to  Cerebral Edema ++++

 Diffuse Axonal Damage

Sub Dural Haem. due to rupture of

vessels in subdural space.