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Head injury


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Head injury

  1. 1. Dr Mukhilesh R M.S
  2. 2. Salient features of Head Injury Most common cause of death following road traffic accidents. Outcome of traumatic brain injury not only personal loss neuro-reahabilitaion long term nursing care supportive care
  3. 3. Pathophysiology of brain Injury Cerebral autoregulation normal blood flow – 55ml/100g/min mean arterial pressure 50-150 mmHg
  4. 4. Monroker Kelle Doctrine ????
  5. 5. Primary vs Secondary brain Injury Primary brain Injury At the time of impact Brainstem and hemispheric contusions Diffuse axonal injury Cortical lacerations
  6. 6. Primary vs Secondary brain Injury Secondary brain Injury sometime after the impact often preventable causes Hypoxia PO2<8kPa Hypotension SBP<90mmhg Raised ICP >20mmhg Pyrexia Cerebral Perfusion Pressure <65mmhg Metabolic Disturbances
  7. 7. Classification Of Head Injury Blunt vs Penetrating Morphological Skull Fractures Vault – open / closed linear / communited depressed / non depressed Base of skull fracture Intracranial Hematoma EDH / SDH/ SAH/ ICH
  8. 8. Clinical Features Rule out multisystem injury esp spinal injury Rule out non accidental causes of collapse syncope aneurysmal SAH hypoglycemia electrolyte imbalance medications and drug abuse
  9. 9. Clinical Features A – Airway B- Breathing C- Circulation D- Disability assesment Pupils and GCS
  10. 10. Glasgow Coma Scale - GCS
  11. 11. Racoon Eyes Battle’s Sign Dilated Pupil
  12. 12. NICE guideline for computed tomography (CT) GCS <13 Focal Neurological deficit Suspected open, depressed or basal skull fracture Seizure Vomiting >1 episode Urgent CT even if none of the above Age>65 coagulopathy antegrade amnesia >30 min
  13. 13. Extradural hematoma Neurosurgical emergency Associated with skull fracture Tearing of meningeal artery PTERION – middle meningeal Can also be dural venous bleed LUCID INTERVAL
  14. 14. Extradural hematoma LENTIFORM SHAPE MASS EFFECT
  15. 15. Management Burr Hole evacuation of hematoma
  16. 16. Subdural Hematoma disruption of cortical vessel or brain laceration significant primary brain injury impaired conscious level diffuse and concave appearance in CT Poor prognosis
  17. 17. CONVEX SHAPE
  18. 18. Clinical Features Small hematomas with little mass effect – conservative management Surgery inappropriate best GCS pupillary reactivity age anticoagulant drugs
  19. 19. Subarachnoid hemorrhage Aneurysms and trauma Traumatic SAH – conservative Rx
  20. 20. Chronic SDH Elderly / anticoagulant Tear in small bridging veins and samll ASDH – silent Hematoma breaks down – mass effect Headache / ICT increased/ focal deficits Rx – evacuation via Burr Hole
  21. 21. Cerebral Contusions Coup injury Contre coup injury
  22. 22. ICP Cerebral perfusion pressure = MAP- ICP CPP to be maintained >65mmhg ICP >20 mmhg – poor outcome ICP monitoring – ventricular or parenchymal
  23. 23. ICP Sedation Diuretics Thermoregulation – pyrexia increases brain metabolism Barbiturates – thiopentones Seizure control Decompressive craniectomy
  24. 24. Skull fractures Vault fractures elevation of depressed segments wound debridement Base of skull fractures CSf rhinorhoea or otorrhoea anterior fossa dural repair
  25. 25. Long term sequelae Neurorehabilitation Pyschological support Seizures