head trauma dr.yasir hamandi. aim of lecture to have an overview about head...
TRANSCRIPT
Head traumaDr.Yasir Hamandi
Aim of lecture
To have an overview about head trauma,classifications,types and the management of each type
objectivesClassification catigoriesClinical classification Mechanism of injuryManagementcomplications
Clinical classification of head injury classifiead into 5 catigories1-skull fractures: may or may not involve damage
to the underlying brainA-linear frac. B-depressed frac. C-basilar frac.
Linear fracture
Depressed fracture
Skull base fracture
2- focal inj.:defined as visible damage that is generally limited to a well circumscribed region;
e.g contusions(coup &countercoup),SDH,EDH,S.A.H,ICH,IVH
Occur in half of all pat. With severe brain inj.,
,and 2/3 of brain inj.related death.
E.D.H
S.D.H
I.C.H
CONTUSSION
3-diffuse brain injury.:occur without macroscopic structural damage
a-cerebral concussion(transient reversible neurological dysfunc. As a result of trauma )
b-diffuse axonal injuryc-ischaemic/hypoxic neuronal
damage
Difuse injuryOccur in about 40% of pat. With
severe brain injury.1/3 of deathsMost prevelant cause of disability in
survivors of TBI.May involve alterations in neural
excitability, neurotransmission,long term receptor dysfunction
Or may be secondary to brain swelling and ischaemic injury
4-penetrating injury
Blast injury
Clinical classification according to severity(G.C.S)
1-G.C.S(3-8) SEVERE
2-G.C.S(9-13)MODERATE
3-G.C.S(14-15) MILD
Mechanism of head injury1- contact:require that the head strike an
object or be struck regardless of whether the blow causes the head to move afterward.
a- local contact effect:-most of linear and depressed
skull fracture,some basilar frac.,E.D.H,COUP Contusions.
E.D.H caused due to contact fracture that either leading to tear meningeal vessels(in adults) or bleeding from frac. Bone in children.
S.D.H : associated contusion and brain laceration result from contact or acceleration effect or result from torn cortical vessels especially in trivial head trauma in old age patients
b-remote contact effect:vault skull frac. Away from the
impact site ,to basilar skull fractures.
2-inertial(acceleration):called head motion because they
result from violent head motion,regardless of whether the head moves because of a direct blow
MANAGEMENT
Ensure patent airway,blood oxygenation adequate
Space occupying haematoma requires urgent evacuation
Scalp lacerations
anticonvalscents
EDH
SDH
DEPRESSED #
DELAYED EFFECTS OF HEAD INJURY
1.post traumatic epilepsy
Early epilepsy (within 1 week from injury)
Occur in 5% of admitted patients with non-missile injury
Frequent in the 1st 24 hours
Focal seizures are as common as generalized
Status epilepticus in 10%
Risk of early epilepsy is high in
Children under 5 years
Patient with post traumatic amnesia
Patients with intracranial hematoma
Patient with compound depressed #
Late epilepsy(after 1 week from injury)Occur in 5% of all patients
admitted to hospitalUsually in 1st yearIn some occur after 10 y from the
injuryUsually generalized but temporal
lobe epilepsy (complex partial )occur in 20 %
Late epilepsy is prevalent in patient with
Early epilepsy 25%
Intracranial hematoma 35%
Compound depressed # 17%
End