types and emergency management of different types of head trauma.

2. HEAD INJURY
Dr Salman Farooq Dar
2ND Year Resident Surgery

3. HEAD INJURY
 Any degree of injury to the head ranging from
scalp laceration to loss of consciousness to
focal neurological deficits.

4. TRAUMATIC BRAIN INJURY(TBI)
Traumatic brain injury(TBI) is a
 nondegenerative, non congenital insult to the
brain from an external mechanical force,
 possibly leading to permanent or temporary
impairment of cognitive , physical and
psychosocial functions,
 with an associated diminished or altered state
of consciousness.

5. TRAUMATIC BRAIN INJURY
High potential for poor outcome
Deaths occur at three points in time after
injury
 - immediately after the injury
 -within two hours after the injury
 -three weeks after injury

6. TYPES OF HEAD INJURY
 Scalp lacerations
 Skull fracture
 Minor head trauma
 Major head trauma

7. LACERATIONS

8. SKULL FRACTURES
 Linear
 Depressed
 Comminuted
 Compound

9. FRACTURES

10. ACCORDING TO THE LOCATION
 Frontal fracture
 Temporal fracture
 Parietal fracture
 Posterior fossa fracture
 Orbital fracture
 Basilar skull fracture

11. TEMPORAL BONE FRACTURE

12. ORBITAL FRACTURE

13. TEST TO DETERMINE CSF LEAKAGE
 Glucose oxidase paper test (unreliable)
 Beta 2 transferrin
 Halo ring sign (bedside)

15. MINOR HEAD TRAUMA
 Concussion… A sudden transient mechanical head
injury with disruption of neuronal activity and a
change in the level of consciousness.
 Typical signs ( LOC for few moments to an
unconscious state for over 3 mins)

16. MAJOR HEAD TRAUMA
 Contusion… it is the bruising of the brain tissue
within a focal area ,usually associated with a
closed head injury
 Coup – contre-coup injury… contusion occur
both at the site of direct impact of the brain on
the skull(coup) at the secondary area of damage
on the opposite side away from
injury(contrecoup) leading to the multiple
contusion areas

18. COMPLICATIONS
INTRACRANIAL HAEMORRHAGES
Extra- axial haemorrhages
 Epidural hematoma
 Subdural hematoma
 Subarachnoid hematoma
Intra- axial hemorrhage
 Intra -parenchymal haemorrhage
 Intra- ventricular haemorrhage

20. EXTRADURAL HEMORRHAGE
 A neurological emergency
 Most common type
 Location….blow to temporal and parietal
 Middle meningeal artery
 Venous-dural venous sinus
 Clinical manifestation (lucid interval)
 Management

21. EDH

22. SUBDURAL HEMATOMA
LOCATION
TYPES
1. ACUTE SUBDURAL HEMATOMA
2. SUBACUTE SUBDURAL HEMATOMA
3. CHRONIC SUBDURAL HEMATOMA
BRIDGING VEINS(CEREBRAL CORTEX
TO THE DURAL SINUSES)
HEMATOMA…SLOWLY PROGRESSIVE

23. SUBDURAL HEMATOMA

24. EDH AND SDH

25. SDH

26. SUB ARACHNOID HEMORRHAGE
LOCATION
CAUSES
RUPTURE OF BERRY ANEURYSM
TRAUMA(FRACTURE AT BASE OF SKULL
LEADING TO INTERNAL CAROTID
ANEURYSM)
CLINICAL FEATURES

27. SAH

28. INTRACEREBRAL HEMORRHAGE
LOCATION
 TYPES
1. INTRAPARENCHYMAL HEMORRHAGE
2. INTRAVENTRICULAR HEMORRHAGE
 CAUSES
 CLINICAL PRESENTATION

29. S/S DEPENDING ON SITE OF HEMORRHAGE
IN ICH
 Cerebral cortex…. monoparesis, focal
sensory loss, hemianopsia.
 BASAL GANGLIA…. hemipresis, dysphagia
 Cerebellum…..ataxia, vertigo
 Brainstem…. cranial nerve deficits, coma

30. DIAGNOSTIC MEASURES
History and physical
examination
 CT scan
 MRI
 PET
 X-RAY

31. TAKING A HX IN HEAD INJURY
 Mechanism of injury
 Loss of conciousness or amnesia
 LOC at scene or during transfer
 Evidence of seizures
 Hx of vomiting
 Pre existing med conditions
 Medications
 Drug and alcohol use

33. GCS

34. CLASSIFICATION

49. FINAL REMARKS
Examine the
patient, not just the
head.