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    Head Injury

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    NorFarah Fatin Anuar
    Head injuries can range from minor to severe based on the Glasgow Coma Scale. Primary injuries occur at the time of impact while secondary injuries develop after, often due to swelling. The Glasgow Coma Scale assesses eye, verbal, and motor responses to determine severity. CT scans are important for diagnosis and show extracerebral injuries like epidural and subdural hematomas. Epidural hematomas cross suture lines while subdurals can cross. Management involves initial stabilization, monitoring for neurological changes, and CT imaging. Surgery may be needed for depressed fractures, expanding hematomas, or seizures without recovery.

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    © All Rights Reserved
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    Head Injury

    Uploaded by

    NorFarah Fatin Anuar
    319 views36 pages
    Head injuries can range from minor to severe based on the Glasgow Coma Scale. Primary injuries occur at the time of impact while secondary injuries develop after, often due to swelling. The Glasgow Coma Scale assesses eye, verbal, and motor responses to determine severity. CT scans are important for diagnosis and show extracerebral injuries like epidural and subdural hematomas. Epidural hematomas cross suture lines while subdurals can cross. Management involves initial stabilization, monitoring for neurological changes, and CT imaging. Surgery may be needed for depressed fractures, expanding hematomas, or seizures without recovery.

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    7. HEAD INJURY.pptx

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    Head injuries can range from minor to severe based on the Glasgow Coma Scale. Primary injuries occur at the time of impact while secondary injuries develop after, often due to swelling. The Glasgow Coma Scale assesses eye, verbal, and motor responses to determine severity. CT scans are important for diagnosis and show extracerebral injuries like epidural and subdural hematomas. Epidural hematomas cross suture lines while subdurals can cross. Management involves initial stabilization, monitoring for neurological changes, and CT imaging. Surgery may be needed for depressed fractures, expanding hematomas, or seizures without recovery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    319 views36 pages

    Head Injury

    Uploaded by

    NorFarah Fatin Anuar
    Head injuries can range from minor to severe based on the Glasgow Coma Scale. Primary injuries occur at the time of impact while secondary injuries develop after, often due to swelling. The Glasgow Coma Scale assesses eye, verbal, and motor responses to determine severity. CT scans are important for diagnosis and show extracerebral injuries like epidural and subdural hematomas. Epidural hematomas cross suture lines while subdurals can cross. Management involves initial stabilization, monitoring for neurological changes, and CT imaging. Surgery may be needed for depressed fractures, expanding hematomas, or seizures without recovery.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 36

    HEAD INJURY

    Trauma to the head with or without trauma to the


    brain

    Classification
    Based on severity- GCS
    Primary or secondary brain injury

    Glasgow Coma Scale

    Severit GCS
    y
    Minor

    15, no LOC

    Mild

    14 or 15, with
    LOC

    Mortali
    ty
    0.1%

    Moderat 9-13
    10%
    **Motor
    score: best predictor of neurological
    e
    outcome

    Severe

    3-8

    40%

    What is the score?


    A patient who is eye opening to painful stimuli, saying
    occasional words and exing to pain
    GCS of 9/15 (E2, V3, M4)

    What if patient is intubated?


    Verbal score T
    Patient who opens eyes to speech (E2), is intubated (VT) and
    localises to pain (M5) has a GCS of 7T/15

    Brain injury
    PRIMARY

    Injury sustained by brain at the time of impact

    Example: Brain laceration, Brain contusion

    SECONDARY

    Injury sustained by brain after the impact

    Often preventable

    Principle causes:

    Extradural haematoma
    (EDH)

    Neurosurgical emergency
    Nearly always associated with a skull fracture
    o skull fracture is associated with tearing of a meningeal artery
    and a haematoma accumulates in the space between bone
    and dura meter

    Most common site: temporal


    As pterion is the thinnest part of the skull
    Overlies the largest meningeal artery the middle meningeal
    artery

    Other regions: frontal and in the posterior fossa

    Clinical presentation
    Initial injury
    Lucid interval - headache but is fully alert and orientated with
    no focal decit
    Rapid deterioration (after minutes or hours)
    contralateral hemiparesis
    reduced conscious level
    ipsilateral pupillary dilatation

    CT scan appearance
    Unilateral
    Biconvex (lentiforms or lens
    shaped)
    Hyperdense lesion
    Sharply demarcated
    Does not cross suture line
    Associated with mass effect on
    underlying brain
    With or without midline shift

    Swirl sign ( Fresh/ non clotted


    blood)
    Less hyperdense/ isodense

    Subdural haematoma
    (SDH)

    Differs from EDH in terms of pathophysiology,


    presentation and prognosis
    Accumulates in the space between the dura and the
    arachnoid
    Disruption of a cortical vessel or brain laceration
    Nearly always associated with a signicant primary
    brain injury

    Clinical presentation
    impaired conscious level from the time of injury
    further deterioration as the haematoma expands

    CT scan appearance
    Unilateral
    Crescent (concave)
    Hyperdense (acute blood)
    Crosses suture line
    Midline shift

    **Hypodense (Black) indicates chronic SDH

    Chronic SDH

    Bilateral
    subacute SDH

    Acute on
    Chronic SDH

    PRINCIPAL
    MANAGEMENT OF HEAD
    TRAUMA

    Principal Management of Head


    Trauma
    Can be divided into:
    1. Initial management
    2. Early Neuro-assessment
    3. Neuro-surgical management

    INITIAL MANAGEMENT
    Primary survey

    Resuscitation

    Secondary
    survey

    Patients neck should be immobilized until cervical


    spine injury has excluded
    ABCDE
    Airway

    adequate airway, secured from obstruction,


    intubate if GCS is <11

    Breathin
    g

    prevents obstructive breathing/


    hypoventilation

    Circulatio
    n

    maintains adequate blood pressure, pulse


    rate, temperature

    Diasabilit
    y

    GCS; pupillary size, equality, reaction to


    light

    Exposure

    exposes patient from head to toe, looks for


    any other bleeding sites

    INITIAL MANAGEMENT
    Primary survey

    Resuscitation

    Secondary
    survey

    Resuscitate patient with uid & electrolytes


    Any bleeding on the scalp should be compressed
    & covered by dressing
    Monitor :
    Airway
    Verbal response
    Response to pain
    Consciousness

    INITIAL MANAGEMENT
    Obtains a rapid history of

    Primary survey

    Resuscitation

    Secondary
    survey

    Also do physical examination- head, face and neck


    Evidence of external head injury- subgaleal
    haematoma or scalp laceration
    Evidence of skull base fracture
    1. Bilateral periorbital oedaema (raccoon eyes)
    2. Battles sign (bruising over mastoid)
    3. CSF rhinorrhoea or otorrhoea
    4. Haemotympanum or bleeding from ear
    Full neurological examination: tone, power,

    Early Neuro-assessment
    1. Assess for the conscious level by using Glasgow Coma Scale
    2. Cranial nerves examinations if possible
    3. Assessment of pupillary size & reaction
    4. Search for CSF leaks from nose, mouth & ears
    5. Examine scalp for laceration and fractures
    6. Assessment of maxillofacial skeleton
    7. Monitor neurological symptoms

    Vomiting
    Altered behaviour (confusion)
    Severe & persistent headache
    Seizure

    Discharge criteria in mild head


    injury
    GSC 15/15 with no focal decits
    Normal CT brain
    Not under inuence of drugs or alcohol
    Accompanied by a responsible adult
    Verbal and written head injury advice to seek medical attention if:

    Persistent/worsening headache despite analgesia


    Persistent vomiting
    Drowsiness
    Visual disturbance
    Limb weakness and numbness

    **Bailey and Loves 26th Edt

    Management
    Observe for few hours especially when there is history
    of LOC at time of injury
    Evaluate if patient need admission or not
    Investigations:
    Imaging (CT scan of brain)
    Other baseline investigations (FBC, coagulation prole, GXM)

    Treatment/intervention

    Radiological investigation
    Skull Xray
    Cervical Xray
    CT scan of brain
    CT scan of cervical
    MRI brain/cervical

    Skull and cervical Xray


    Use to detect fractures or radio opaque foreign object in
    the skull.

    CT scan
    The current standard investigation
    Should be done in ALL patient with signicant head
    injury
    Demonstrates mass effect, ventricular size and
    conguration, bone injuries, and acute hemorrhage.
    Limitations: insensitivity in detecting small and
    nonhemorrhagic lesion (eg contusion)

    Extracerebral lesion
    Extradural hematoma
    Subdural hematoma
    Fractures of skull base or vault

    Intracerebral lesion
    Odema
    Contusion
    Intracerebral hematoma

    Basal cistern
    Midline
    Sulci gyri
    Ventricles
    Bones

    Epidural
    haemorrhage

    Subdural
    haemorrhage

    Edema with
    compression on
    ventricles

    Intracerebral
    haemorrhage

    MRI
    More sensitive and detail imaging study
    Demonstrate: anatomic & vascular structures,
    myelination process & detection small hemorrhages
    Disadvantage: time consuming, sensitivity to patient
    motion and incompatibility with various medical devices

    Indication For Surgery


    1.
    2.
    3.
    4.

    Depressed skull fracture


    Epidural haematoma ~ burr holes/craniotomy
    Subdural haematoma ~ craniotomy
    Seizure without full recovery

    Skull fracture
    Exploration, debridement and elevation of fragment
    Compound fracture has high incidence of infection,
    neurological decit and late onset epilepsy hence
    antibiotic, antiepilectics are indicated
    Skull base fracture may associated with CSF leak hence
    pneumococcal vaccination is indicatied

    Epidural hematoma
    Immediate transfer to neurosurgical unit
    Immediate evacuation in deteriorating or comatose
    patient or those with large bleeds with burr holes or
    craniotomy
    Close observation with serial imaging

    Subdural hematoma
    Similar to epidural hematoma
    Smaller bleeds can be managed conservatively with ICP
    monitoring
    Evacuation using burr holes/craniotomy

    Cerebral contusion
    Rarely requires surgery unless to reduce mass effect

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