Head and Brain Injury
By
Dr Mir Afzal
Khaskheli
MBBS,CHPE,(MD),(MSPH).
LEARNING OBJECTIVES
Head Injury
Scalp Injury
Skull Injury
Brain Injury
BASICS ANATOMY
SKULL
HUMAN BRAIN
INTRODUCTION
Head injury is a
broad classification
that includes injury
to the scalp , skull or
brain
Head injury is a
general term use to
describe any trauma
to the head and the
most specifically to
the brain itself.
Head injury refers to
trauma to the head
CLASSIFICATION
According to glass gow coma scale
1. Mild (GCS 13-15 with loss of
consciousness to 15 min)
2. Moderate(GCS 9-10 with loss of
consciousness for up to 6 hr)
3. Severe (GCS 3-8 with loss of
consiousness greater than 6hr)
RISK FACTORS
Color blindness
Alcohol addictions
Youngsters
Vertigo
Males,(about 1.5 times as likely as females
to sustain a brain injury)
Young children or teenager(especially
infants to 4-year-olds and 15-19-years olds)
Certain military personnel (for example,
paratroopers)
African Americans(who have the highest
death rate from brain injury) .
CAUSES OF HEAD INJURY
Penetrating trauma
Blunt head trauma – direct blow
Motor vehicle accident
Assault
Sport injury
Cerebral edema
Intra cranial hemorrhage
Gunsot trauma
TYPES OF HEAD INJURY
ACCORDING TO :
Open and closed injury
OR
Site of injury:
A. scalp injury
B. skull injury
C. Brain injury
B. Skull injury: head injury may cause a
minor head skull fracture, which may or may
not be associated with injury to the brain.
Skull fracture: it is a break in the bone
surrounding the brain and other structures
within the skull
SKULL FRACTURE
(1.) DEPRESSED SKULL FRACTURE :
These are common after forceful impact
by blunt objects-most
commonly ,hammers,rocks,or other
heavy but fairly small objects.
(2.) LINEAR SKULL FRACTURE: a
common injury , espially in
[Link] is a simple break in the skull
that follows a relatively straight line.
(3.) BASILAR SKULL FRACTURE: A
fracture of the bones that form the
base of the skull and results from
severe blunt head trauma of significant
force .
C. BRAIN INJURY
Traumatic brain injury is the result of an external
mechanical force applied to the cranium and
intracranial contents, leading to temporay or
permanent impairments ,functional disability ,or
psychosocial maladjustment.
TYPES:
(1).CONCUSSION :cerebral concussion is considered
a mild brain injury and temporary loss of
neurological function with no apparent structural
damage.
(2).CONTUSION :brain contusion are bruises of the
brain tissue that occur as a result of brain
[Link] some cases ,brain contusion lead to
hemorrhages which are absorbed into brain tissue.
(3)DIFFUSE AXONAL INJURY
Axon tear within the white matter of brain.
DAI is one of the most common and devastating
types of traumatic brain injury and is a major
cause of unconsciousness and persistent
vegetative state after severe head trauma.
4).INTRACRANIAL HEMORRHAGE: Intracranial
describes any bleeding with in the
skull .Bleeding in the skull major may not be
associated with a skull fracture .It is a serious
condition that often requires surgery and
extensive recovery time.
There are three types :
A. Subdural hematoma – when a vein
ruptures between the brain and duramater .
B .Epidural hematoma - it is caused by a
rupture between the dura mater and the
skull.
c. Intracerebral hematoma - when blood
collects within the brain tissue.
DIAGNOSTIC
EVALUATION
History and physical examination
CT scan and MRI
X –Ray of skull
Positron emission tomography
Neuropsychological
Electroencephalography
CSF analysis (halo ring)
COMPLICATIONS
Coma
Chronic headaches
Loss of or changes in sensations,
hearing, vision , taste, or smell
Paralysis
Seizures
Speech and language problems
death
MANAGEMENT
IMMEDIATE MANAGEMENT
The immediate management of head injury
includes:
Control of airway,by intubation and
mechanical ventilation if necessary.
Oxygen Therapy,and arterial blood gas
analysis.
Restoration of circulating blood volume,
using fluid, colloid and blood
[Link] venous access is required
(at least two large intravenous cannulae).
Cervical spine examination and imaging.
Temporary immobilisation of limb fractures.
MEDICAL
MANAGEMENT
[Link] of increased intra
cranial pressure
Administering manitol .
Drainage of cerebrospinal fluid.
Elevation of the head of the bed
Complete bed rest
Dopamine to maintain cerebral
perfusion pressure above 50mgHg
Glucocorticoids :dexamethasone to
reduce cerebral edema
[Link] THERAPY :
Administration of antibiotics is required to prevent
infection with open skull fractures and penetrating
wound .
[Link] THERAPY :
Medication to prevent seizures may be given to prevent or
treat seizures that occur from the head injury.
[Link] MEASURES:
Ventilatory support
Vasopressors may be required to maintain blood pressure
Fluid and electrolyte maintenance
Nutritional support
Pain and anxiety management .
SURGICAL MANAGEMENT
Craniotomy it is used to remove the
hematoma from the brain.
Lumber puncture it is used to drain
the CSF ,if the intracranial volume is
increased.
Cerebral angioplasty it is used to
open partially blocked vertebral and
carotid arteries in the neck ,as well as
blood vessels within the brain.
Elevation of depressed fractures of the
skull.
Suturing of severe scalp lacerations.
SUMMARY
Head injury is any trauma to the
scalp ,skull, or brain . It can be open and
closed head injury.
Some common causes of head injuries
are falls, motor vehicle accidents ,and
sports injuries.
The warning signs of head injury are
repeated vomiting or nausea ,seizures,
slurred speech or loss of coordination
etc. and there treatment depends on
the type of injury and how severe it is .
