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SUDIHARTO
NEUROSURGERY DIVISION
SURGERY DEPARTMENT
INTRUCTIONAL OBJECTIVE
I.
Departement of Neurosurgery
Lecturer : DR. dr. P. Sudiharto
Topic of Lecture :
Head injury
1. Mechanism of head injury
2. Pathophysiology of head injury
a. Primary brain injury
b. Secondary brain injury
3. Diagnosis
a. History, physical and neurological examination
b. Laboratory tests
c. Imaging studies
4. Principles of head injury management
a. Initial management
b. Early management of increased intracranial
pressure
c. Surgical management
INTRUCTIONAL OBJECTIVE
I.
Departement of Neurosurgery
Lecturer : DR. dr. P. Sudiharto
Topic of Lecture :
Head injury
1. Mechanism of head injury
2. Pathophysiology of head injury
a. Primary brain injury
b. Secondary brain injury
3. Diagnosis
a. History, physical and neurological examination
b. Laboratory tests
c. Imaging studies
4. Principles of head injury management
a. Initial management
b. Early management of increased intracranial
pressure
c. Surgical management
DEFINITION
Head injury is defined an injury to any
part of the head (e,g, face, skull)
Brain injury denotes damage to the
brain. That head and brain injuries can
occur in combination (Ruff, R, 2005)
Craniocerebral injury can involve
scalp. Skull or brain in any
combination (Pitts & Nockels, 1994)
MECHANISTIC CAUSES OF
HEAD INJURIES
Head injuries are due to one of two basic
mechanisms, contact or acceleration
injuries
Focal Injuries
Diffus Injuries
- Linear
- Depressed
- Basilar
- Contusions
* Coup
* Centre coup
* Intermediate
- Hematomas
* Extradural/epidural
* Subdural
* Intracerebral
- Concussion
* mild
* classic
- Diffus axonal injury
* Mild
* Moderate
* severe
HISTORY
PHYSICAL EXAMINATION
NEUROLOGIC EXAMINATION
LABORATORY TESTS
IMAGING STUDIES
A. HISTORY
B. PHYSICAL EXAMINATION
Initial examination should be rapid and systematic
Attention must be directed to assesment of other mayor
injuries (spinal, chest, abdominalm extremities)
Inspect and feel the entire scalp
Note any injuries to the aye
Inspect the face for evidence of maxillary and mandibular
fractures
Basal skull fractures maybe recognized by the presence of :
- fresh bleeding from an ear
- cerebrospinal fluid otorrhea or rinorrhea
- bilateral ecchymoses confined to the orbits
C. INITIAL NEUROLOGIC
EXAMINATION
Glasgow Coma Score
- eye opening
- motor response
- verbal response
Pupillary size and response to light, and symmetry
Eye movement
Motor power, symmetry of limb movement
Gross sensory examination
Reflex activity
Cranial nerve deficit
D. LABORATORY TESTS
E. IMAGING STUDIES
Skull X-rays
Computerized tomography scan
(CT Scan)
Magnetic Resonance Imaging
(MRI)
TATALAKSANA
P
R
I
M
A
R
Y
S
U
R
V
E
Y
BREATHING
CIRCULATION
KONSEPNYA
RESPONSIBILITAS TERPENTING
MANAJEMEN ABC : CEGAH
POTENSIAL TERJADINYA
SECONDARY BRAIN DAMAGE
SCALP
SKULL
MENINGES
BRAIN
LCS
TENTORIUM
GCS
ICP
MENINGES
Tiga lapis : duramater, arachnoid, piamater
Arteri Meningea Media, potensial terlibat pada kasus EDH
CAIRAN SEREBROSPINAL
Diproduksi oleh pleksus koroideus
Rata-rata 30 ml per jam
Bersirkulasi
TENTORIUM
Membagi 2 ruangan intrakranial
Supratentorial dan Infratentorial
TEKANAN INTRAKRANIAL
Normal : 10 mmHg ( 136 mm air )
Makin tinggi TIK makin jelek prognosis
HUKUM MONRO-KELLIE
Prinsip : total volume intrakranial bersifat TETAP,
Oleh karena kranium merupakan NON EXPANSILE BOX
Monro Kellie
Vk = V darah + V likwor + V parenkim
mmHg
Fatal
100
Tekanan
Intrakranial
60
50
Disfungsi
Otak
50
40
30
Obati
20
Volume Intrakranial
Normal
10
0
KOMPONEN MATA
KOMPONEN MOTORIK
KOMPONEN VERBAL
Fraktur Impresi
CT scan
Impresi Fraktur
BASILAR SKULL
FRACTURES
EPIDURAL
HEMATOM
Epidural
ACUTE
EPIDURAL
HEMATOMA
Subdural hematom
Pre operasi
Pasca Operasi
Intraserebral
hematom
Korpus
Alienum
FUNGSI OTAK
Sisi dominan untuk yang tidak kidal adl yg
sebelah kiri
Orang kidal, 75 % sisi dominan adalah kiri
Fungsi sisi dominan adalah untuk bahasa
dan memori yang berdasarkan bahasa
Sisi kanan untuk memori visual
LOBUS FRONTALIS
1. PRE-SENTRAL GIRUS
Pusat motorik untuk muka, tangan, kaki,
badan, dsb.
2. AREA BROCA
Pada sisi dominan adalah pusat bicara
ekspresif motorik
3. AREA MOTOR TAMBAHAN
Untuk gerakan mata dan kepala sisi yang
berlawanan
4. AREA PRE-FRONTAL
Untuk inisiatif dan personalitas
5. PARASENTRAL LOBUS
Pusat penahan BAK dan BAB