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    Head Trauma: Victor Liberto

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    Muhamad Fernando Mahardika
    This document discusses head trauma and its effects on the brain and surrounding structures. It covers topics like the layers of the scalp, the skull, meninges, brain anatomy, cerebral blood flow, intracranial pressure, brain herniation, and classifications of head injury. Maintaining proper intracranial pressure and cerebral blood flow is important for reducing secondary brain injury after a head trauma.

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    Head Trauma: Victor Liberto

    Uploaded by

    Muhamad Fernando Mahardika
    37 views40 pages
    This document discusses head trauma and its effects on the brain and surrounding structures. It covers topics like the layers of the scalp, the skull, meninges, brain anatomy, cerebral blood flow, intracranial pressure, brain herniation, and classifications of head injury. Maintaining proper intracranial pressure and cerebral blood flow is important for reducing secondary brain injury after a head trauma.

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    Head Trauma

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    This document discusses head trauma and its effects on the brain and surrounding structures. It covers topics like the layers of the scalp, the skull, meninges, brain anatomy, cerebral blood flow, intracranial pressure, brain herniation, and classifications of head injury. Maintaining proper intracranial pressure and cerebral blood flow is important for reducing secondary brain injury after a head trauma.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    37 views40 pages

    Head Trauma: Victor Liberto

    Uploaded by

    Muhamad Fernando Mahardika
    This document discusses head trauma and its effects on the brain and surrounding structures. It covers topics like the layers of the scalp, the skull, meninges, brain anatomy, cerebral blood flow, intracranial pressure, brain herniation, and classifications of head injury. Maintaining proper intracranial pressure and cerebral blood flow is important for reducing secondary brain injury after a head trauma.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 40

    Head Trauma

    Victor Liberto
    Perspective…
    SCALP
    Monro-Kellie Doctrine Skull/Cervical

    Intracranial Pressure Meninges/Spaces

    Cerebral Blood Flow Brain


    Head
    Trauma

    Classification of Injury Blood Vessel

    Acute Neurologic Assessment Cerebrospinal Fluid

    Cranial Nerve Tentorium


    SCALP
    Skin

    Pericranium Sub Cutaneous

    Loose areolar tissue Aponeurosis


    SCALP
    Skin
    Outermost, thick
    SubCutaneous
    Rich blood supply
    Vessels do not fully constrict if lacerated
    Galea Aponeurotica
    Occipito & temporo-parietalis muscles
    Loose areolar
    Loose attachments, Avulsion, Subgaleal
    hematomas
    Pericranium
    Deepest, is firmly adhered to the skull itself
    Skull
    8 neurocranium

    2 to 6 mm

    Thinnest
    Temporal
    14 Facial Muscle

    Cranial Vault & Base


    Skull
    • Base is irregular
    • Floor of cranial cavity:
    – Anterior: Frontal
    – Middle: Temporal
    – Posterior: Brainstem &
    Cerebellum
    • Foramen

    Diploe
    Skull
    • Cranial vault is rigid and non expandable
    • Average volume in adults 1.9 liter
    • Cranial contents exit or enter the skull
    through many foramina
    • The largest, the foramen magnum, is the
    site of exit of the brainstem and spinal
    cord from the cranium
    Basilar Skull Fracture
    • Blood in ear canal
    • Hemotympanum
    • Rhinorrhea
    • Otorrhea
    • Retroauricular hematoma (Battle’s Sign)
    • Periorbital ecchymosis (Racoon Eye)
    • Cranial nerve deficit: Facial paralysis,
    Tinnitus, Nystagmus
    A case in a construction project
    Meninges
    • Epidural
    • Subdural (vein from brain
    surface to superior sagital sinus)

    • Venous sinuses (drainage


    from the brain, laceration of sinuses =
    massive hemorrhage ) Duramater

    • Meningeal artery Arachnoid


    Piamater
    (epidural, epidural hematoma, middle
    meningeal artery over temporal fossa)

    • CSF (subarachnoid, brain injury


    leads to SAH
    Meninges
    • Dura folds: protect and compartmentalize
    different parts of brain
    • Midline Falx-cerebri separates 2
    hemispheres
    • Tentorium cerebelli partitions cerebellum
    and brainstem from hemispheres
    • The U-shaped free margin of this dural
    fold: transtentorial herniation syndromes
    that can complicate severe head injury
    Brain
    The only organ that can study itself and everything else

    Cells that make up the


    brain:
    • Neuron
    • Astrocytes
    • Oligodendrocytes
    • Schwan’s Cell
    • Satellite Cell
    Whose brain is this?
    • Removed after
    several hours of his
    death…
    Whose brain is this?
    • 98.9 % DNA
    sequence
    Brain
    • Roughly 100 billion neurons
    • 1 neuron 15 million synapses
    • Localized and whole area
    Brain
    • Major divisions:
    – Cerebrum
    – Diencephalon (thalamus & hypothalamus)
    – Limbic System
    – Brainstem
    • Midbrain, Pons, Medulla Oblongata
    – Cerebellum
    Cerebrum

    Parietal

    Limbic System
    Thalamus
    Frontal Occipital
    Hypothalamus

    Midbrain

    RAS
    Temporal
    Pons
    Cerebellum
    Reticular Formation or RAS
    • Sensory reaches RF
    • RF stimulate cortex:
    wakefulness
    • Decreased activity in RF result
    in sleep
    • Injured RF: unconscious even
    to strong stimuli
    • RF filter incoming sensory
    signal
    • Cerebral cortex may activate
    RF
    • RF regulates motor activity
    • Enhance or inhibit certain
    spinal nerves
    • Basal ganglia or
    nuclei:
    – Dopamine
    – Inhibit motor function
    – Controlling certain
    muscular activity
    Brain Injury
    • Primary injury:
    – Contusion; coup, countercoup
    – Diffuse axonal injury (white matter), confusion to
    coma
    – Foreign object
    – Skull fracture
    • Secondary injury:
    – Hypoxia, hypocapnia, hypercapnia, increased ICP,
    decreased CBF, hyperthermia, electrolyte, pH
    disturbance
    Hypocapnia…
    Cerebrospinal Fluid
    • Choroid plexus (20 ml/h), primarily in lateral
    ventricles > Monroe > Third ventricle > Sylvius >
    Fourth ventricle > exit through
    – Luscka (to SAS/great cerebral vein cistern) and
    – Magendie (to SAS/cistern magna)
    • CSF from the ventricular system into
    subarachnoid space surrounds the brain &
    spinal cord
    • Arachnoid granulation
    65 to 195 mm H2O
    or
    5 to 15 mm Hg

    Blood can occlude?

    Brain injury can


    alter pH

    pH: pulmonary
    drive & cerebral
    blood flow
    Perspective…
    SCALP
    Monro-Kellie Doctrine Skull/Cervical

    Intracranial Pressure Meninges/Spaces

    Cerebral Blood Flow Brain


    Head
    Trauma

    Classification of Injury Blood Vessel

    Acute Neurologic Assessment Cerebrospinal Fluid

    Cranial Nerve Tentorium


    Tentorium
    • Supra-tentorial compartment
    • Infra-tentorial compartment
    • Midbrain passes through large aperture:
    tentorial incisura
    • N III may become compressed during
    temporal lobe (uncus) herniation
    • Parasympathetic fiber (pupillary constrictor
    lie on the surface of N III; Dilatation due to
    unopposed sympathetic
    • Uncal Herniation:
    – N III
    – Parasympathetic fiber
    – Corticospinal tract
    • Uncal Herniation:
    – Ipsilateral Pupil
    Dilatation
    – Contralateral
    hemiplegia
    Kernohan’s Notch Syndrome
    • Result of the compression of the cerebral
    peduncle, part of midbrain against the
    tentorium due to transtentorial herniation
    • Hemiplegia or hemiparesis and pupil
    dilatation on the same side as the
    hematoma (or mass)
    Intra Cranial Pressure
    • Elevated ICP reduces cerebral perfusion and
    cause ischemia
    • Normal resting state: 10 mmHg, more than 20
    mmHg; poor outcome
    • Intracranial pressure results from contributions
    from intracranial fluid compartments:
    – Brain tissue (more than 80% fluid)
    – Arterial blood
    – Venous blood
    – Cerebrospinal fluid
    Monro-Kellie Doctrine
    • The total volume of intracranial contents
    must remain constant

    Venous Arterial Brain CSF

    Venous Arterial Brain MASS CSF

    Venous Arterial Brain MASS CSF


    Brain Herniation
    • Cingulate
    • Brainstem
    • Uncal
    • Cerebellar tonsil
    Cerebral Blood Flow
    • 50 to 55 ml/100 grams brain tissue/minute
    (human brain is 1400 grams)
    • …raised ICP
    • …ischemia > ischemic cascade > cellular
    damage > edema, etc
    • Every effort to enhance/control CBF:
    – Reducing elevated ICP
    – Maintain intravascular volume
    – Maintain MAP
    – Restoring normal oxygenation and normocapnia
    • Compensatory mechanism…
    Hypocapnia…

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