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    Diffuse Injury FIx

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    oomculun
    This document discusses diffuse injuries, which form a continuum of brain damage caused by acceleration-deceleration forces. It describes three levels of diffuse injury from mild to severe: 1) a mild concussion with temporary neurological dysfunction and amnesia, 2) a classical cerebral concussion with loss of consciousness and post-traumatic amnesia, and 3) diffuse axonal injury associated with prolonged coma. It also covers the primary and secondary phases of acute head injury, biomechanics of impact and inertial injuries, classification using CT scans, histological grading of diffuse injuries, and management including surgery to control intracranial pressure.

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    Diffuse Injury FIx

    Uploaded by

    oomculun
    14 views22 pages
    This document discusses diffuse injuries, which form a continuum of brain damage caused by acceleration-deceleration forces. It describes three levels of diffuse injury from mild to severe: 1) a mild concussion with temporary neurological dysfunction and amnesia, 2) a classical cerebral concussion with loss of consciousness and post-traumatic amnesia, and 3) diffuse axonal injury associated with prolonged coma. It also covers the primary and secondary phases of acute head injury, biomechanics of impact and inertial injuries, classification using CT scans, histological grading of diffuse injuries, and management including surgery to control intracranial pressure.

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    kuliah Undip

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    This document discusses diffuse injuries, which form a continuum of brain damage caused by acceleration-deceleration forces. It describes three levels of diffuse injury from mild to severe: 1) a mild concussion with temporary neurological dysfunction and amnesia, 2) a classical cerebral concussion with loss of consciousness and post-traumatic amnesia, and 3) diffuse axonal injury associated with prolonged coma. It also covers the primary and secondary phases of acute head injury, biomechanics of impact and inertial injuries, classification using CT scans, histological grading of diffuse injuries, and management including surgery to control intracranial pressure.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views22 pages

    Diffuse Injury FIx

    Uploaded by

    oomculun
    This document discusses diffuse injuries, which form a continuum of brain damage caused by acceleration-deceleration forces. It describes three levels of diffuse injury from mild to severe: 1) a mild concussion with temporary neurological dysfunction and amnesia, 2) a classical cerebral concussion with loss of consciousness and post-traumatic amnesia, and 3) diffuse axonal injury associated with prolonged coma. It also covers the primary and secondary phases of acute head injury, biomechanics of impact and inertial injuries, classification using CT scans, histological grading of diffuse injuries, and management including surgery to control intracranial pressure.

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    © All Rights Reserved
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    of 22

    DIFFUSE

    INJURY

    Pembimbing :
    dr. Erie B.P.S Andar, SpBS, PAK
    Classification of Head Injury
    Diffuse Injuries

    Diffuse injuries form a continuum of brain damage


    caused by increasing amounts of acceleration –
    deceleration injury to the brain
    Is the most common type of head injury
    Diffuse Injury

    1. A mild concussion
    • is an injury in which consciousness is preserved but
    there is a noticeable degree of temporary
    neurological dysfunction
    • The mildest form of concussion results in confusion
    and disorientation without amnesia  completely
    reversible and is not associated with any major
    sequele
    • A slightly greater injury causes confusion with both
    retrograde and anterograde amnesia ( before and
    after injury)
    2. A classical cerebral concussion

    • is an injury that results in loss of consciousness.


    Always is accompanied by some degree of
    posttraumatic amnesia and the length of amnesia
    is a good measure of the severity of the injury

    • The loss of consciousness is transient and


    reversible
    3. Diffuse axonal injury (DAI)

    • is the term used to explain prolonged post


    traumatic coma that is not due to a mass lesion or
    ischemic insult.
    • They often demonstrate evidence of decortication
    or decerebration ( motor posturing) and often
    remain severely disabled if they survive.
    • Often exhibit autonomic dysfunction such as
    hypertension, hyperhidrosis and hyperpyrexia and
    previously thought to have primary brainstem
    injury.
    Phase of Acute Head Injury

    • Acute head injury is a progressive process

    Primary head injury

    Secondary head injury


    Primary Head Injury

    • Caused by the mechanical deformation of brain


    tissue and blood vessel at the moment of injury
    • Disruption at macroscopis and microscopis level
    • Evolve hours or days through a series of interrelated
    biochemical and metabolic changes, inflammatory
    reactions and progressive structural damages to
    neurones, glia, and cerebral vasculature
    Secondary head injury

    Refers to delayed effect of events initiated by the


    injury

    Systemic events occuring after injury that have the


    potential to add to the damage to neurones, axons,
    and the cerebral vasculature
    Biomechanics of Head Injury
    a. Impact Injury
     Direct effects that contact has on the head
     Direct impact to the cranium results in local
    distortion and propagation of stress waves from
    the area of impact through succesively deeper
    layers of the cranium
     Degree of distortion of the determined by the
    velocity of impact
     Ussualy involves energy of high magnitude acting
    directly on the skull for a short duration (approx
    <50msec)
    b. Inertial Injury (contre coup)
    direct impact can result in movement of the skull
    and the brain in direction away from the impacting
    force
     Brain legs behind the skull because of its inertia and
    and surrounded by CSF
     Effects of relative movement between the skull and
    the brain
    Computed tomography classification of head injury by the
    Traumatic Coma Data
    Diffuse Injury Clasification on
    Histological Appearance
    1. Diffuse Injury Grade I
    Abnormalities are limited to histological evidence of
    axonal damage, throughout the white matter without
    focal concentration in either the corpus calosum or in
    the brain stem
    2 Diffuse Injury grade II
    Wider distribution of axonal injury accompanying a
    larger focus of axonal damage in the corpus callosum
    3. Diffuse Injury Grade III
    diffuse damage to axons associated with larger foci of
    axonal damage in both corpus calosum and brain stem
    MANAGEMENT ?????????
    Surgery for ICP control

    When the conservative measures has failed


    The two basic approaches are either resection of
    brain parenchyma or removal of a portion of the
    skull.
    MATUR NUWUN
    TERIMA KASIH

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