head injury (hi)
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Head Injury (HI). Hassan Bukhari General and Trauma Surgeon Apr 29, 2012. Objective. By the end of this discussion, you should be familiar with Anatomy and physiology of the cranium Classification of HI Diagnosis Clinical Imaging. Contents. Introduction Classification of HI Diagnosis - PowerPoint PPT PresentationTRANSCRIPT
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Head Injury (HI)
Hassan BukhariGeneral and Trauma SurgeonApr 29, 2012
![Page 2: Head Injury (HI)](https://reader035.vdocuments.site/reader035/viewer/2022062218/56816415550346895dd5c833/html5/thumbnails/2.jpg)
Objective• By the end of this discussion, you should
be familiar with• Anatomy and physiology of the cranium• Classification of HI• Diagnosis
• Clinical• Imaging
![Page 3: Head Injury (HI)](https://reader035.vdocuments.site/reader035/viewer/2022062218/56816415550346895dd5c833/html5/thumbnails/3.jpg)
Contents• Introduction• Classification of HI• Diagnosis• Treatment• MCQs
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Introduction• Trauma is the leading cause of death in young patients
worldwide• Head injury (HI) accounts for >50%
• Goals of Intervention in HI• To reduce mortality and improve outcome• To prevent secondary brain damage• Cannot do much about primary brain damage
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Anatomy of Cranium
• SCALP• Skull• Meninges• Brain• Ventricles• Tentorium
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Anatomy of the cranium
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Munro-Kellie Doctrine
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Classification• Mechanism
• Blunt vs penetrating• Severity
• Minor• Moderate• Sever
• Morphology• Skull fracture• Intracranial lesions
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Blunt vs. Penetrating injuries
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Skull fracture
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Intracranial lesions• Focal
• Epidural• Subdural• Subarachnoid• Intracerebral
• Diffuse• Concussion• Diffuse axonal injury• Multiple contusions
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Epidural hematoma (EH)
• Convex collection• More in young• Source: MMA• Incidence: about 10%• MVC, fall and assault
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Epidural hematoma• Lucid interval: observed in up to 50%.• About 40% will remain conscious throughout.• Mortality
• Overall is 10%
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Subdural hematoma
• Extracranial,crescentic collection
• Source: bridging vein• MVC, fall and assault
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Epidural vs. Subdural
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Intracerebral hemorrhage vs. ED vs. SD
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Special injury
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Diagnosis
• Clinical
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Diagnosis• Imaging
• Skull x-ray• CT• MRI
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MCQ #1
• 34 YO M, involved in MCV, present in coma. CT brain as shown, Diagnosis is
A- SubduralB- EpiduralC- SubarachnoidD- Intracerebral bleedE- Brain contusion
✓
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MCQ #2
• A 44 YO, fall from 5 meters. Present with CGS of 8. CT as shown. Diagnosis is:
A- SubduralB- EpiduralC- SubarachnoidD- Intracerebral bleedE- Brain contusion
✓
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MCQ #3• 57 YO F, was hit by baseball bat to the head. She had
transient loss of consciousness. On arrival, she is full conscious and asymptomatic. During observation, she became confused and her GCS is 10. What do you call this phenomena?
A- Lucid phase intervalB- Cushion intervalC- Rebound phenomenaD- Countercoup phenomena
✓
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Treatment
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Treatment• Medical
• General• Specific
• Conservative• Control ICP
• Surgical• Decompressive craniotomy
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MCQ #4• A 20 YO M, involved in
MCC. Came to ER with the following finding (see photo). These finding are A- Raccoon eyes B- RhinorrheaC- Basal skull fractureD- All of the aboveE- Non of the above
✓
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In summary• Anatomy and physiology of the cranium• Classification of HI• Diagnosis
• Clinical• Imaging
![Page 28: Head Injury (HI)](https://reader035.vdocuments.site/reader035/viewer/2022062218/56816415550346895dd5c833/html5/thumbnails/28.jpg)
Reference• American Association of Neurological Surgeons: Guidelines for
Surgical Management of TBI 2006. Neurosurgery 58:S2-1-S2-3, 2006.
• American College of Surgeons: ATLS® Student Course. 8th edition