HEAD INJURIES
Prepared By : Chong Kel Liang (BMS 17091112)
Introduction of Head Injuries in Adults
Defined as blunt and/or penetrating injury to the head (above the neck) and
or/ brain due to external force with temporary or permanent impairment in
brain function which may or may not result in underlying structural
changes in the brain
Head injuries are commonly categorized
1. Open head injuries
2. Closed head injuries
Epidemiology of Head Injuries
In the Malaysian National Trauma Database 2009 report, blunt trauma made
up 96 % of all injuries
Road Traffic Accident (RTA) accounted for 75% of cases with motorcyclist
being most commonly injured
High proportion of those with major trauma (85%) had injuries to the head
and neck with Abbreviated Injury Scale (AIS) ≥3
Injury was the fifth (7.86 %) commonest cause of hospitalization in Malaysian
public hospital in 2014 with RTA being the commonest cause of injury- related
hospitalization
Pathophysiology of Head Injuries
1. Head Injury occurs from tensile forces of trauma that shears or tears the blood
vessels and axons of the nerve cells
2. Damage in blood vessels cause hemorrhage within the brain tissues leading to
hematoma formation, cerebral edema and increase intracranial pressure. Axonal
swelling and damage leads to axonal disconnection
3. Hematoma compresses the nerve cells causing nerve damage. Lack of transmission
of impulses from the nerve cells leading to altered motor and sensory functions
4. Loss of neuronal function leading to profound loss of consciousness or a
progressive vegetative state
Etiology
Classification of Head injury
• Severity of head injury is classified according to Glasgow
Coma Scale (GCS)
Glasgow Coma Scale (GCS)
Types of Head Injuries
• Skull fracture
• Concussion
• Contusion
• Intracranial hematoma
• Diffuse axonal injury (DAI)
Skull fracture
• A crack or break in the skull, with or without
a laceration to the scalp
• Types
Linear (most common)
linear break in the skull bone
Depressed
displacement of the bone
Diastatic
fracture along the suture lines
Basal skull fracture
fracture at the base of the skull
Concussion
• Physiological dysfunction without anatomical
or radiological abnormality
• Cause loss of consciousness / memory
• Complete recovery
• Multiple concussions may lead to chronic
traumatic encephalopathy
Contusion
• Bruising on the brain itself
• Impair a wide range of brain functions,
depending on size and location
• Larger contusions cause brain edema and
increased ICP
Intracranial hematoma
• Collection of blood within the skull
• By the rupture of a blood vessel
within the brain or from trauma
• Types
Epidural haemorrhage
Subdural haemorrhage
Subarachnoid haemorrhage
Intracerebral haemorrhage
• Epidural haemorrhage
Blood between skull and dura mater
Result from laceration of middle meningeal artery due
to temporal bone fracture
Classically presents with lucid interval
• Subdural haemorrhage
Blood between dura mater and arachnoid
Acute SDH: high-speed acceleration / deceleration
trauma which tear small bridging veins
Chronic SDH: elderly and alcoholics days to weeks
after initial injury
• Subarachnoid haemorrhage
Bleeding within the subarachnoid space
Common causes of SAH is a berry
aneurysm and head trauma
Diffuse axonal injury (DAI)
• Arises from high impact injury
• Axons are stretched or torn
• Permanent damage the brain cells
• Major causes of unconsciousness
and persistent vegetative state
after head trauma
References
• CPG Early Management of Head Injury in Adults
• SRB ‘s Manual of Surgery 5th Edition
• https://www.neurologicstudies.com/leading-causes-of-tbi-are/
