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    Tbi, Sci' S Lecture Part 2.

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    Kim Gonzales
    The document describes different categories of diffuse brain injury including mild, moderate, and severe traumatic brain injury. It discusses the symptoms and deficits associated with each category such as prolonged coma, cognitive impairments, and motor deficits. The document also describes different types of traumatic hemorrhages that can occur within the brain including epidural, subdural, subarachnoid, parenchymal, and intraventricular hemorrhages. It provides details on the sources of bleeding, clinical presentations, and onset of symptoms for each type of hemorrhage.

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    Tbi, Sci' S Lecture Part 2.

    Uploaded by

    Kim Gonzales
    59 views17 pages
    The document describes different categories of diffuse brain injury including mild, moderate, and severe traumatic brain injury. It discusses the symptoms and deficits associated with each category such as prolonged coma, cognitive impairments, and motor deficits. The document also describes different types of traumatic hemorrhages that can occur within the brain including epidural, subdural, subarachnoid, parenchymal, and intraventricular hemorrhages. It provides details on the sources of bleeding, clinical presentations, and onset of symptoms for each type of hemorrhage.

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    Tbi, Sci' s Lecture Part 2.

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    The document describes different categories of diffuse brain injury including mild, moderate, and severe traumatic brain injury. It discusses the symptoms and deficits associated with each category such as prolonged coma, cognitive impairments, and motor deficits. The document also describes different types of traumatic hemorrhages that can occur within the brain including epidural, subdural, subarachnoid, parenchymal, and intraventricular hemorrhages. It provides details on the sources of bleeding, clinical presentations, and onset of symptoms for each type of hemorrhage.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    59 views17 pages

    Tbi, Sci' S Lecture Part 2.

    Uploaded by

    Kim Gonzales
    The document describes different categories of diffuse brain injury including mild, moderate, and severe traumatic brain injury. It discusses the symptoms and deficits associated with each category such as prolonged coma, cognitive impairments, and motor deficits. The document also describes different types of traumatic hemorrhages that can occur within the brain including epidural, subdural, subarachnoid, parenchymal, and intraventricular hemorrhages. It provides details on the sources of bleeding, clinical presentations, and onset of symptoms for each type of hemorrhage.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Categories of Diffuse Brain Injury

    DAI
    Mild (coma > 6 -24 hrs)
    Persistent residual cognitive, phsychologic,
    sensorimotor deficit

    Decorticate and decerebrate posturing


    Experience prolonged period of stupor
    Permanent deficit in memory, attention,
    abstraction, reasoning, problem solving,
    executive function, vision or perception
    and language.

    5
    Decorticate vs Decerebrate
    Categories of Diffuse Brain Injury
    Moderate
    Widespread impairment cerebral cortex, diencephalon,
    tearing of axons both hemisphere

    Transitory decortication or decerebration.


    Unconsciousness lasting days or weeks.
    On awakening the person is confused and suffer long
    period of post-traumatic anterograde and retrograde
    amnesia.
    Categories of Diffuse Brain Injury
    Severe (LOC > week)
    Severe mechanical disruptions of axons in
    both hemisphere, diencephalon and brain stem.

     Immediate autonomic dysfunction that disappear


    in few weeks.
    IICP 4-6 days after injury.
    compromised coordinated movements with verbal
    and written communication, inability to learn and reason,
    inability to modulate behavior.
    Compound Fracture
    Object strikes the head
    with great force or
    head strike the object
    forcefully temporal or
    occipital blow
    upward impact of
    cervical vertebrae
    (basilar skull fracture)
    Penetrating Injury
    Missile (bullets) or
    sharp projectile
    (knives, axes,
    screwdriver)
    CENTRIPETAL APPROACH
    (outside to inside)
    • –Scalp
    • –Cranium
    • – Epidural
    -
    • –Subdural
    • –Subarachnoid
    • –Intra-parenchymal
    • –Intra-ventricular
    Traumatic Hemorrhage:
    Subgaleal
    Cephalohematoma
    – Subperiosteal Outer Table
    Epidural (Extradural)
    – Subperiosteal Inner Table
    Subdural
    – ‘Epi-arachnoid’
    Subarachnoid
    Parenchymal Hemorrhage
    Intra-ventricular
    EPIDURAL HEMATOMA
    Source of Bleeding
    MENINGEAL VESSELS
    Arterial (high pressure)
    Venous (low pressure)
    DURAL SINUS

    High flow, low pressure


    OTHERS

    Diploic veins (Fx)


    Marrow sinusoids
    Epidural Hematoma:
    EPIDURAL HEMATOMA
    Trauma -> fracture &
    concussion
    Tearing/stripping of both
    layers
    from inner table
    Laceration of outer periosteal
    layer
    Laceration of meningeal
    vessels
    Inner (meningeal dura) intact
    Blood between naked bone
    EPIDURAL HEMATOMA
    EPIDURAL HEMATOMA
    Significant trauma
    Fracture & concussion (l.o.c)
    Lucid Interval
    – pt Wakes Up
    – 40% pts.

    Delayed neurologic Sx (hrs. Later)


    Herniation, coma and death
    SUBDURAL HEMATOMA
    SUBDURAL HEMATOMA
    HEMATOMA TYPES OF INJURY ONSET OF S/S CLINICAL MANIFESTATION

    Acute Severe Head Injury within hours Rapid deterioration to drowsiness,


    agitation, stuporous, coma, signs
    of brain stem compression, pupil
    dilation contralateral hemiparesis.

    Subacute Moderate Head 2 hours to Lucid , Drowsiness, stuporous


    Injury weeks after coma, Increase ICP

    Chronic Mild Head Injury weeks - Dull headache, slowness in


    months after thinking, apathy, drowsiness,
    contralateral hemipareresis,
    progressive neurologic changes,
    aphasia, papilledema, LOC
    INTRACEREBRAL HEMATOMA
    INTRACEREBRAL HEMATOMA
     Usually frontal and temporal lobes
     May occur in hemispheric deep white matter
     Small blood vessels injured by shearing forces
     Acts as expanding mass, compresses tissue,
    and causes edema
     May appear 3- 10 days after head injury

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