Head Injuries
Head Injuries
The high incidence :-
The head is the target of choice
When the victim is pushed or knocked
to the ground, he often strikes his head.
The brain and its coverings are
vulnerable to degrees of blunt trauma
that would rarely be lethal if applied to
other areas.
Head injuries for easiness discussed
under three headings:
Scalp injuries.
Skull injuries.
Brain injuries.
Scalp Injuries:-
the Scalp is the outermost covering of the head
and it has five layers from out side to inwards:
Skin
connective tissue
galae aponeurotica( epicranial aponeurosis) aponeurosis of
the occipito frontalis muscle.
loose areolor tissue
pericranium.
Injuries include:
Abrasions
Contusions – Black eye due to bleeding
into the soft tissue caused by :
A direct blow into the orbit .
An injury to upper front of the scalp.
A fracture of base of the skull :
anterior cranial fossa
membranous bone of the orbit roof.
Skull Injuries:-
Skull is a diploic bone having an outer table
and inner table. The outer table is thicker and
stronger, while the inner table is thinner and
weaker. A spongy bone is in between giving
elasticity to the bone.
( 2 types of bone – cancellous, trabecular,
spongy unit trabecula
_ compact, cortical bone unit
osteon including Haversian and Volkman
canals.)
2 types:
fracture of the vault of the skull.
fracture of the base of the skull.
Vault Fractures:-
Fissured fracture:-
(Linear fracture) involving only outer
or inner table or both.
Stellate Fracture:-
(Radiating fracture) comminuted
fracture with fracture fragments held
intact.
Mosaic Fracture:-
(Spider’s web fracture) comminuted
depressed fracture with tissues
radiating from it forming a spider’s
web.
Depressed Fracture:-
(Signature fracture) the fractured
bone fragments are driven inwards
and it may correspond in size, shape
to the causative weapon.
Elevated Fracture:-
One end of the fractured fragment is
elevated above the surface of the skull
while the other dip down into the
cranial cavity and injure the dura
mater of brain directly.
Diastic Fracture :-
(Diastasis, suture line fracture) fracture
occurring along the skull sutures,
occurs in children and young person.
Gutter Fracture:
thickness of the skull bone is affected
leading to an irregular depressed
fracture of the inner table.
Comminuted Fracture:-
(Crushed fracture) the bone is broken
into pieces.
Fractures of Base of the Skull:-
Characterized by escape of blood and CSF
through the nose, ears and back of the neck
corresponding to anterior, middle and
posterior cranial fossa fractures.
Ring Fracture:- (Around the foramen
magnum) due to fall and landing on the
crown of the head.
Hinge Fracture:- (Motorcyclist’s
fracture) fracture of the base of the skull,
the fracture line runs from side to side
across the floor of the middle cranial
fossa and through the pituitary fossa.
Hinge fracture, “motorcylist’s fracture”
Brain Injuries and Intracranial
Haemorrhage:-
Cerebral concussion
“ a condition where there is a temporary
derangement of the neuronal activity
without demonstrable organic lesion in
the brain.”
Clinically
loss of consciousness
flaccidity of muscles
followed by recovery of the
consciousness leading to loss of
consciousness again.
Concussion followed by:
Post Concussion Syndrome: Headache,
dizziness, nervousness and epilepsy.
Lucid Interval:-
The period of recovered
consciousness between two bouts of
unconsciousness, mentally a person
is found to be perfectly normal during
this phase.
Extradual Haemorrhage (EDH):-
Bleeding outside the dura mater
Causes:-
Commoner due to fracture of the temporal bone and
rupture middle meningeal artery.
fracture of the frontal bone, occuipital bone and
vault.
Collected blood leads to pressure effects and
displacement of the brain, increased ICP, loss
of consciousness and coma (in few hours or
days).
Extraduarl haematoma
Findings:-
Ipsilateral dilated pupil.
Contralatral paresis.
Lucid interval.
Automatic movements.
May be confused for alcoholic
intoxication and the victim may be put in
custody under the charge of
drunkenness.
Subdural Haemorrhage (SDH):-
Subdural space has no mesothelial
lining, haemorrhage can not get
resolved, it leads to formation of a blood
cyst.
Common in children and old people.
Causes:-
Gliding movement between dura and
arachoid mater
bruices and lacerations of the brain.
Minor trauma like sudden jerky
movement of head (in old people leading
to bilateral subdural haemorrhage)
Usually it is incidental in nature, with no
manifestations for long time apart of
slight confusion
forgetfulness
emotional disturbance.
It is mistaken for:
schizophrenia in young victims
presenile or senile dementia in old people.
Subarachnoid Haemorrhage (SAH):-
Causes:-
All traumatic causes
Prolonged hyperextension of the neck.
Diseases like atheroschlerosis, hypertension
or leukaemia.
Berry aneurysms of basilar artery.
Manifested by sudden loss of
consciousness.
No haematoma formation, blood
removed by lysis or phagocytosis.
Spinal Cord Injuries:-
Basically four types:
Concussion
Whiplash injury: hyperextension followed
by hyper flexion as in rear impact in car
accidents. It leads to dislocation at C4-C6
with haemorrhage in spinal cord substance.
Leads to quadriplegia.
Compression of the spinal cord – in
fracture dislocation C4-C6, T3-T6, T10-L3
in Pott’s disease.
Pithing: killing by pushing a fine needle
into the nape of the neck between base
of skull and first cervical vertebrae.
Laceration of the spinal cord.
twisting of the neck accompanied with
laceration without evident external
injury as in infanticide, wresting.
