Академический Документы
Профессиональный Документы
Культура Документы
Mizan Kidanu
April 03/2013
OUTLINE
Introduction
Epidemiology
Anatomy
Causes
Classification
Diagnosis
Management
Complication
INTRODUCTION
A head injury is any trauma that leads to injury
EPIDEMIOLOGY
Number one killer in trauma
25% of all trauma deaths
50% of all deaths from MVA
200,000 people in the world live with the
ANATOMY
Connective tissue
contain blood vessels of the scalp
Aponeurosis
fibrous sheet, found over much of
the vertex
attaches occipitalis to frontalis m
Periosteum
adheres to the suture lines of the skull
collection of blood beneath this layer outlines the
affected bone cephalohematoma (children)
Dura
endosteum and true meningeal layer
forms falx, tentorium, diaphragm
Arachinoid
vascular membrane
arachinoid granulations
Pia
highly vascular
dips into sulci and fissures
carries cortical vessels
sport, or at home
Assaults
Blunt Vs Penetrating
2.
Primary Vs Secondary
3.
Diagnosis
oHistory - nasal bleeding,
oPhysical examination
Raccoon eyes
Battle sign
Rhinorrhea,......
Management:
impact
Concussion
temporary neuronal dysfunction after blunt head trauma
head CT is normal, & deficits resolve over minutes to hours
Contusion/laceration
bruise of the brain
breakdown of small vessels and extravasation
of blood into the brain
Mechanisms
Coup & counter-coup injuries
Common sites:-
hypoxia
hypotension
Intracranial
hematoma
brain edema
raised ICP
infection
DIAGNOSIS
History
Age
Loss of consciousness
Cause, circumstance and mechanism of
injury
Presence of headache & vomiting
Seizures
Anticoagulant use,.
Investigations
Skull radiograph
CXR and X-ray of cervical spines
CT-Scan - first line investigation
Anticonvulsants
may decrease early posttrauma seizures but
GCS
BP, HR, RR, and Temperature
oxygen saturation
pupil size & reactivity
limb movement
EPIDURAL HEMATOMA
Usually from torn middle meningeal artery
and/or vein
Other causes:
Clinical presentation
Diagnostic evaluation
CT scan - lens shaped collection
- hematoma volume
estimation
Management
craniotomy / ?burr hole
Prognosis-mortality -10%
SUBDURAL HEMATOMA
Pathophysiology
coma in (56%)
lucid interval (12-38%)
posterior fossa SDH - signs of increased ICP
Result from:
CT SCAN FEATURES
subdural interface
CT features
After 2 weeks, hypodense
crescentic collections
Acute-on-chronic SDHs can
further complicate the images,
with hyperdense fresh
haemorrhage intermixed, or
layering posteriorly, within the
chronic collection
Do not cross the midline
Management
Acute SDH - Surgery for symptomatic & unstable pt
Surgery
burr hole
craniotomy
Nonoperative Mx
clinically stable
clot thickness <10mm
no clinical or CT signs of herniation
repeat CT scans 6-8 hrs after initial scan
Chronic SDH
Cushings Triad:
bradycardia
hypertension
abnormal respiration
Pupillary changes
Papilledema
brain herniation
1. subfalcine herniation
2. uncal herniation
3. central transtentorial
herniation
4. tonsillar herniation
and otorrhea
Epilepsy - about 80% arise in 2yrs
Hydrocephalus- usually due to atrophied white
matter
Amnesia (PTA)
Postconcussional Sx
Posttraumatic encephalopathy
Cranial nerve injury - in up to 30% pts
REFERENCES
Mark S. Greenberg: Hand Book of Neurosurgery;
6th ed
Bailey & Loves: Short Practice of Surgery; 24 th ed,
2004
Peter J Morris: Oxford Text Book of Surgery; 2 nd
ed, 2002
Schwartz's: Principles of Surgery; 9th ed, 2010