This document defines and classifies different types of head injuries. It discusses primary and secondary head injuries, open and closed head injuries, and the severity of injuries. It also describes different types of injuries like skull fractures, intracranial hematomas including extradural, subdural, subarachnoid and intracerebral hemorrhages. Diffuse axonal injury is also discussed. Head injuries are classified based on Glasgow Coma Scale, post-traumatic amnesia and loss of consciousness.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
I prepared this presentation for CME at 108 Emergency Services GVK-EMRI, Bangalore in January 2013. I kept it simple and concise as the CME was attended by EMTs too. Hope its of help to any medical professional out there.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
I prepared this presentation for CME at 108 Emergency Services GVK-EMRI, Bangalore in January 2013. I kept it simple and concise as the CME was attended by EMTs too. Hope its of help to any medical professional out there.
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
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2. Definitions
Head injury – any trauma to the head
• with/without injury to the brain due to external force with
• temporary/permanent impairment in brain function
• may/may not result in underlying structural changes in the brain.
3. Classification of Head Injury
• Primary/ Secondary
• Type of injury (Open/ Closed or Blunt/ Penetrating)
• Site of injury
• Severity of injury
4. Primary Head Injury
• Irreversible cellular injury as a direct result of the injury
• Examples:
• Skull fracture
• Contusion
• Hematoma
• Subarachnoid or focal hemorrhage
• laceration
5. Secondary Head Injury
• Damage to cells that are not initially injured
• Occurs hours to weeks after injury
Systemic effects
• Hypotension or hypertension
• Hypoxia
• Electrolyte/glucose/acid-base
abnormalities
Intracranial effects
• Ischemia
• Edema
• Infection
• Seizure
• Hemorrhage
• Hydrocephalus
6. Types of Injury
Open Head Injury/Penetrating Injury
• Results from bullet, knives etc.
• Largely focal damage
• Penetration of the skull
Closed Head Injury/ Blunt Injury
• Resulting from falls/ motor vehicle crashes etc
• Focal damage and diffuse damage
• No penetration to the skull
7. Site of Injury
Scalp Injury (Scalp lacerations)
• scalp is highly vascular, caused profuse bleeding
• major complication is infection
Skull Fractures
Minor Head Trauma
Major Head Trauma
9. Skull Fractures
Linear Fractures
• Break in the continuity of bone without alteration of
relationship of parts
• Cause : Low velocity injuries
Depressed Fractures
• Inward indentation of skull
• Cause : Powerful blow
Comminuted fractures
• Multiple linear fractures with fragmentation of bones into
pieces
Compound fractures
• Depressed skull fractures and scalp laceration communicating
intracranial cavity
10. Basilar Fracture
Involve the floor of the skull's brain cavity
• Otorrhoea, rhinorrhoea
(due to leakage of spinal fluid into the nose and ears)
• Bulging of tympanic membrane
• Battle’s sign (unilateral bruising behind the ear, extending down the neck)
• Facial paralysis (may involve 7th or 8th cranial nerve injury)
• Tinnittus , vertigo
11. Minor Head Trauma
Concussion
• A sudden transient mechanical head injury with disruption of
neuronal activity and a change in the LOC.
• It occurs when the brain suddenly shifts inside the skull and knocks
against the skulls bony surface
• Variable period of unconsciousness or confusion
• Retrograde Short term Amnesia
• Headache, dizziness, nausea , ringing inears
12. Cerebral Contusion
• Most Common Focal injury to brain
• "salt-and-pepper" appearance on CAT scan.
• Often occurs at anteroinferior frontal, anterior
temporal and occipital regions
• Result of an impact of the brain against the skull
during an acceleration/deceleration injury.
• Petechial hemorrhages --> coalesce--> intracerebral
hematoma within hours and few days.
15. Extradural Hemorrhage
• Blunt trauma to temporoparietal region
• temporoparietal locus – middle meningeal artery ( most common)
Clinical features:
• LOC → Lucid Interval → Unconsciousness
• Signs and symptoms of raised ICP;
• Focal neurological deficit
• Signs and symptoms of cerebral herniation
• may associate with skull fractures
18. Subdural Hemorrhage
• sudden acceleration-deceleration injury with tearing of bridging veins
or direct trauma
• Risk factors: elderly, dementia, alcoholics; shaken baby syndrome;
patients on anticoagulants
• Associated with DAI
• Classified as acute, subacute or chronic
• Acute< 72 hours
• Chronic > 3 weeks
19. Subdural Hemorrhage
Acute Subdural Haematoma (<72 Hours)
• Associated with major head injury involving contusion/laceration
• Typically appears on CT scans as hyperdense crescents
• Clinical features: headache; fluctuating LOC; confusion; dilated fixed pupils; deviated gaze
Subacute Subdural Haematoma (4-21 days)
• Less severe contusion and head trauma (failure to regain consciousness may be an indicator)
• CT scan: Iso-dense/Hypodense
Chronic Subdural Haematoma (>3 weeks)
• Can present days to weeks after the initial head injury, especially in the elderly and alcoholic
populations
• May cause focal neurologic deficits, mental status changes, metabolic abnormalities, and/or
seizures
• CT scans typically shows a hypodense crescentic collection tracking between the dura and
the brain.
21. Subarachnoid Hemorrhage
Caused by extravasation of blood into the subarachnoid space between
the pia and arachnoid membranes
Causes:
• Traumatic (fracture of base of skull leading to internal carotid artery
aneurysm)
• Non- traumatic (80%):
• Ruptured cerebral aneurysm (most common: Berry Aneurysm)
• Arteriovenous malformation (AVM)
• Amyloid angiopathy; blood dyscrasias; vasculitis
Clinical Features: explosive/thunderclap headache (“worst headache”);
nausea/vomiting; decreased consciousness/coma; signs of meningeal
irritation
23. Intracerebral Hemorrhage
Haemorrhage that occurs within the brain tissues or ventricles, causing a blood clot deep in the middle of the brain
(hard to remove); pressure from this clot may cause damage to the brain (requiring surgery to relieve pressure)
Two main types:
• Intra-parenchymal haemorrhage: ICH extending into brain parenchyma (Hypertensive vasculopathy)
• Intra-ventricular haemorrhage: ICH extending into ventricles (Trauma)
• Causes: Hypertensive vasculopathy (70-80%); Ruptured AVM; Trauma; Blood Dyscrasias
Clinical presentation: rapidly progressive severe headache, building over several minutes, often accompanied by focal
neurological deficits, nausea/vomiting, decreased level of consciousness
Signs/symptoms depends of sites of haemorrhage:
• Basal ganglia/internal capsule – hemiparesis, dysphasia
• Cerebellum – ataxia, vertigo
• Pons – cranial nerve deficits, coma
• Cerebral cortex – hemiparesis, hemisensory loss, hemianopsia, dysphasia
24. Diffuse Axonal Injury (DAI)
• One of the most common and devastating types of traumatic brain injury
• Differential Movement of Adjacent regions of Brain during acceleration and Deceleration
• Damage occurs over a more widespread area than in focal brain injury (extensive lesions in white
matter tracts); process takes approximately 12-24 hours
• Major cause of prolonged COMA after traumatic brain injury
• disruption of ascending reticular connections to Cortex
• Clinical signs: decreased consciousness level; increased ICP; decerebration/decortication posture; global
cerebral oedema
25. Severity of Traumatic Brain Injury
GCS PTA (Post
traumatic
amnesia)
LOC
Mild 13-15 <1day 0-30mins
Moderate 9–12 >1 to <7 days >30 min to
<24 hours
Severe 3–8 >7 days >24hours
Editor's Notes
Traumatic contusion. Axial non-enhanced CT shows patchy hemorrhagic foci mixed with low-density edema (salt-and-pepper appearance) in the left frontal and temporal lobes. Small SDH and bilateral SAH were also demonstrated. Perimesencephalic cistern closed bilaterally due to bilateral subtentorial herniation.
