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    Head Injuries

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    lionel andrea
    The document discusses various types of head injuries including classifications, mechanisms, processes, injuries to specific areas like the scalp and skull, and complications. It covers topics like skull fractures, contusions, lacerations, intracranial hemorrhages, diffuse brain injuries, raised intracranial pressure, and brain herniation.

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    Head Injuries

    Uploaded by

    lionel andrea
    3 views39 pages
    The document discusses various types of head injuries including classifications, mechanisms, processes, injuries to specific areas like the scalp and skull, and complications. It covers topics like skull fractures, contusions, lacerations, intracranial hemorrhages, diffuse brain injuries, raised intracranial pressure, and brain herniation.

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    The document discusses various types of head injuries including classifications, mechanisms, processes, injuries to specific areas like the scalp and skull, and complications. It covers topics like skull fractures, contusions, lacerations, intracranial hemorrhages, diffuse brain injuries, raised intracranial pressure, and brain herniation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views39 pages

    Head Injuries

    Uploaded by

    lionel andrea
    The document discusses various types of head injuries including classifications, mechanisms, processes, injuries to specific areas like the scalp and skull, and complications. It covers topics like skull fractures, contusions, lacerations, intracranial hemorrhages, diffuse brain injuries, raised intracranial pressure, and brain herniation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 39

    HEAD

    INJURIES
    Introduction

    „ Major medical and surgical problem


    „ Important cause of morbidity and
    mortality worldwide
    „ Clinically challenging
    „ Medico-legal implications
    Classification

    „ Sharp/blunt force
    „ Direct/indirect violence
    „ Anatomical components involved
    „ Focal/diffuse injuries
    „ Weapon/instrument used
    „ Primary/secondary
    Mechanism

    „ Contact phenomenon
    – Local
    – Distant
    „ Acceleration-deceleration phenomenon
    – Translational/linear
    – Rotational/angular
    Process

    „ Primary injury
    „ Delayed consequences of primary
    injury
    „ Secondary/additional injury
    „ Recovery and functional outcome
    Scalp Injuries

    „ Application of force
    „ Blunt/sharp force
    „ Lacerated and incised wounds
    „ Lacerations may bleed profusely
    „ Infection/sepsis
    Skull Fractures

    „ 80% in fatal cases


    „ Higher incidence of intracranial
    haemorrhage
    „ Indicates application of considerable
    force but site important because of
    variations in bone thickness
    „ May be simple or compound
    Skull Fractures
    „ Classification:
    – Linear
    – Depressed
    – Comminuted
    – Growing
    – Ring fracture
    – Hinge fracture
    – Slot fracture
    – Diastatic
    – Coup and contrecoup
    Contusions

    „ Commonest traumatic brain lesion


    „ Wedge-shaped heterogenous areas of
    haemorrhage and pulping of the brain
    tissue
    „ Pia-arachnoid intact
    „ End result is a shrunken, pigmented
    and gliosed scar
    „ Can be aged histologically
    Contusions

    „ Classification:
    – Coup
    – Contrecoup
    – Intermediary coup
    – Fracture
    – Herniation/flap
    – Gliding
    – Ponto-medullary rents or tears
    Lacerations

    „ Tearing injury of pia-arachnoid layer


    and underlying brain tissue
    „ Usually associated with focal
    subarachnoid haemorrhage
    „ Inferior aspect of brain commonly
    affected
    Intracranial Haemorrhage
    „ Primary
    – Epidural
    – Subdural
    – Contusion/laceration associated
    – Diffuse axonal injury
    – Avulsion or rupture of vessels
    „ Secondary
    – Enlargement of primary haemorrhages
    – Duret haemorrhages
    Extradural Haemorrhage

    „ Extravasation of blood between dura


    mater and inner table of skull
    „ Typically biconvex and temporal
    „ Overlying fracture in 85% of cases
    „ Commoner in falls and road traffic
    accidents
    „ Injury to middle meningeal artery or
    veins and diploic veins or dural venous
    sinuses
    Subdural Haemorrhage

    „ Extravasation of blood between the


    dura and the outer surface of the
    leptomeninges
    „ 5-22% of head injuries
    „ Common in falls and assaults
    Subdural Haemorrhage

    „ Pathogenesis:
    – Acceleration strains stretch and rupture
    subdural bridging veins
    – Tearing of veins on surface of cortical
    contusions
    – Subdural extension of haemorrhage from
    ruptured berry aneurysms
    Subdural Haemorrhage
    „ Types:
    – Acute
    „ <48 hours
    „ Clotted blood
    – Subacute
    „ 2-14 days
    „ Clotted and fluid blood
    – Chronic
    „ >2 weeks
    „ Fluid blood
    Subarachnoid
    Haemorrhage
    „ Haemorrhage between arachnoid and
    pia mater
    „ Diffuse lesion because of lack of
    anatomical barriers
    „ Blood mixes with CSF and follows CSF
    pathways
    „ In traumatic cases, the small pia-
    arachnoid vessels are involved
    Intracerebral
    Haemorrhage
    „ Haemorrhages within the substance of
    the brain
    „ Independent of cortical contusions
    „ Commonest at subcortical site
    „ Vary in size
    „ May be lobar, ganglionic or mixed
    distribution
    „ Resolve as pigmented slit-like cavities
    Intraventricular
    Haemorrhage
    „ 2.6-7% of head injuries
    „ Shearing of brain and subependymal
    veins
    „ Dissection of parenchymal
    haematomas into the ventriculatr
    system
    Diffuse Brain Injuries
    „ Spectrum of primary brain injury
    „ Includes:
    – Mild concussion
    „ Temporary neurological dysfunction
    „ Consciousness preserved
    – Classic cerebral concussion
    „ Transient, reversible loss if consciousness <6 hours
    with amnesia
    „ No persistent focal deficits
    – Diffuse axonal injury
    Diffuse Axonal Injury

    „ Prolonged traumatic coma >6 hours


    „ No lucid interval present
    „ Not due to mass lesions or hypoxic-
    ischaemic encephalopathy
    „ Common in vehicle accidents, falls
    from great heights and some cases of
    assault
    Diffuse Axonal Injury

    „ Types:
    – Mild (6-24 hours)
    – Moderate (>24 hours)
    – Severe (>24 hours with brainstem
    and autonomic signs)
    Diffuse Axonal Injury
    „ Diagnostic Triad:
    – Focal lesions in corpus callosum
    – Focal lesions in dorsolateral quadrants of the
    rostral brainstem
    – Diffuse damage to axons
    „ Other sites of haemorrhage:
    – Parasagittal/gliding contusions
    – Cerebral white matter
    – Deep grey matter (ganglionic)
    – intraventricular
    Diffuse Axonal Injury

    „ Histology:
    – Depends on length of survival
    – Neuroaxonal spheroids or retraction balls
    with short survival
    – Microglial clusters with intermediate
    survival (weeks)
    – Long tract (Wallerian) degeneration with
    long survival (months)
    Raised Intracranial
    Pressure
    „ Life-threatening complication of intracranial
    injuries
    „ Monro-Kellie Hypothesis
    „ Clinical Features:
    – Headache
    – Vomiting
    – Visual disturbances
    – Neck stiffness
    – Seizures
    – Focal neurological signs
    Raised Intracranial
    Pressure
    „ Pathological Findings:
    – Flattening of gyri and narrowing of sulci but
    accentuation of pattern with subdural
    haemorrhages
    – Cerebral surface dry
    – Ipsilateral ventricles become smaller but
    contralateral dilatation observed
    – Midline shift
    – Bony changes in skull
    – Brain herniation
    Brain Herniation
    „ May be external or internal
    „ External herniation occurs through skull
    defects with toothpasting or mushrooming
    of brain tissue as well as haemorrhagic
    pressure necrosis
    „ Internal hernias:
    – Subfalcine/cingulate gyrus
    – Parahippocampal gyrus/uncal/tentorial
    – Central/diencephalic
    – Cerebellar tonsillar/foramen magnum
    Subfalcine Hernia
    „ Herniation of cingulate gyrus of frontal
    lobe under the free edge of the falx
    cerebri
    „ Pressure necrosis of the cingulate
    gyrus
    „ Compression of pericallosal arteries
    leading to infarction
    „ Clinical effect is of weakness or
    sensory loss in one or both legs
    Central Hernia

    „ Caudal displacement of the inner parts


    of the brain and rostral brainstem with
    resultant obliteration of the
    interpeduncular fossa
    Cerebellar Tonsillar
    Hernia

    „ Unilateral or bilateral downward


    displacement of the cerebellar tonsils
    between the inner rim of the foramen
    magnum and the medulla with
    resultant compression of the medulla
    Parahippocampal Gyrus
    Herniation

    „ Caudal displacement of the


    parahippocampal gyrus under the
    opening of the tentorium cerebelli
    „ May be unilateral, bilateral, partial or
    circumferential
    Parahippocampal Gyrus
    Herniation
    „ Effects:
    – Transverse compression of midbrain
    – Compression of aqueduct of Sylvius
    – Kernohan’s notch/lesion
    – Ipsilateral CNIII palsy with resultant
    dilatation of the pupil
    – Compression of posterior cerebral artery
    Hypoxic-Ischaemic
    Encephalopathy
    „ Ischaemic brain insults >3-4 minutes
    may result in permanent neuronal
    damage
    „ Spectrum of damage ranges from focal
    neuronal necrosis to frank infarction
    „ Results from generalised decrease in
    cerebral perfusion pressure or an
    obstruction of cerebral blood flow
    Hypoxic-Ischaemic
    Encephalopathy

    „ Histology:
    – Cerebral cortex
    – Parahippocampal gyrus
    – Cerebellar folia and dentate nucleus
    – Basal ganglia
    – Brainstem

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