Head traumaDr.Yasir Hamandi

Aim of lecture

To have an overview about head trauma,classifications,types and the management of each type

objectivesClassification catigoriesClinical classification Mechanism of injuryManagementcomplications

Clinical classification of head injury classifiead into 5 catigories1-skull fractures: may or may not involve damage

to the underlying brainA-linear frac. B-depressed frac. C-basilar frac.

Linear fracture

Depressed fracture

Skull base fracture

2- focal inj.:defined as visible damage that is generally limited to a well circumscribed region;

e.g contusions(coup &countercoup),SDH,EDH,S.A.H,ICH,IVH

Occur in half of all pat. With severe brain inj.,

,and 2/3 of brain inj.related death.

E.D.H

S.D.H

I.C.H

CONTUSSION

3-diffuse brain injury.:occur without macroscopic structural damage

a-cerebral concussion(transient reversible neurological dysfunc. As a result of trauma )

b-diffuse axonal injuryc-ischaemic/hypoxic neuronal

damage

Difuse injuryOccur in about 40% of pat. With

severe brain injury.1/3 of deathsMost prevelant cause of disability in

survivors of TBI.May involve alterations in neural

excitability, neurotransmission,long term receptor dysfunction

Or may be secondary to brain swelling and ischaemic injury

4-penetrating injury

Blast injury

Clinical classification according to severity(G.C.S)

1-G.C.S(3-8) SEVERE

2-G.C.S(9-13)MODERATE

3-G.C.S(14-15) MILD

Mechanism of head injury1- contact:require that the head strike an

object or be struck regardless of whether the blow causes the head to move afterward.

a- local contact effect:-most of linear and depressed

skull fracture,some basilar frac.,E.D.H,COUP Contusions.

E.D.H caused due to contact fracture that either leading to tear meningeal vessels(in adults) or bleeding from frac. Bone in children.

S.D.H : associated contusion and brain laceration result from contact or acceleration effect or result from torn cortical vessels especially in trivial head trauma in old age patients

b-remote contact effect:vault skull frac. Away from the

impact site ,to basilar skull fractures.

2-inertial(acceleration):called head motion because they

result from violent head motion,regardless of whether the head moves because of a direct blow

MANAGEMENT

Ensure patent airway,blood oxygenation adequate

Space occupying haematoma requires urgent evacuation

Scalp lacerations

anticonvalscents

EDH

SDH

DEPRESSED #

DELAYED EFFECTS OF HEAD INJURY

1.post traumatic epilepsy

Early epilepsy (within 1 week from injury)

Occur in 5% of admitted patients with non-missile injury

Frequent in the 1st 24 hours

Focal seizures are as common as generalized

Status epilepticus in 10%

Risk of early epilepsy is high in

Children under 5 years

Patient with post traumatic amnesia

Patients with intracranial hematoma

Patient with compound depressed #

Late epilepsy(after 1 week from injury)Occur in 5% of all patients

admitted to hospitalUsually in 1st yearIn some occur after 10 y from the

injuryUsually generalized but temporal

lobe epilepsy (complex partial )occur in 20 %

Late epilepsy is prevalent in patient with

Early epilepsy 25%

Intracranial hematoma 35%

Compound depressed # 17%

End