head injury

1. HEAD
INJURY
Dr. dr. Hanif G. Tobing, SpBS(K)
KSM Ilmu Bedah Saraf

2. #1
SOUTH EAST ASIA
HEAD INJURY INCIDENCE

3. TRAFFIC INJURY
MOST FREQUENT MORTILITY FROM
700.000 DEATH ANNUALLY
3 from 4 cases in developing country
Other cause: Fall from height, attack

4. What is head injury
All forms of injury to the scalp, skull, to brain tissue, are caused by a blunt,
sharp, or combined mechanism. A head injury is caused by the effect of force to
the head that may have caused a dysfunction of the brain and in addition may
have led to an injury of the brain, scalp, skull bone, vessels, and dura.
Source: Damiani, D., & Damiani, D. (2017). Brain Concussion: New Classifications and Current Physiopathological Knowledge of the Disease.

5. Cause?
Traffic accidents
(single, double,
pedestrian)
Falling from a
height
Hobbies:
bicycle,
rollerblading,
skateboard
Sharp trauma
(stab, stab)
Physical
violence (boxing,
fistfights)
Combination:
Rolled over in
the accident

6. Head Injury Severity
 Consciousness value 13-15
 Fainting <30 minutes
 Posttraumatic amnesia <24 hours
Minor
 Consciousness value 9-12
 Fainting 30 minutes-24 hours
 Posttraumatic amnesia 24 hours-7
days
Moderate
 Consciousness value 3-8
 Fainting >24 hours
 Posttraumatic amnesia
>7 days
Severe

7. Watchout for
LUCID INTERVAL
After syncope period, patient
can consciouss again, for
some hours to syncope
again later.
EMERGENCY

8. Tanda Bahaya Cedera Kepala?
Lucid Interval Pingsan >2 jam Muntah berulang
Nyeri kepala
hebat
Tidak ingat
kejadian/amnesia
30 menit
Kejang
Kelemahan tubuh
sesisi
Luka terbuka
dengan
perdarahan aktif
Keluar
darah/cairan dari
hidung/telinga
Luka terbuka
dengan dasar
tulang patah
Lebam berat pada
mata dan
gangguan
penglihatan

9. Why is it dangerous?
The skull is a container with a fixed
volume. When there is an increase in
volume in the form of blood or brain
swelling, it will cause the brain structure
to be pushed and the risk of pressing the
brain stem, which is the center of
consciousness.
Roytowski, D., & Figaji, A. (2013). Raised intracranial
pressure: What it is and how to recognise it. Continuing
Medical Education, 31(3), 85-90

10. IMMEDIATELY GO TO
HOSPITAL FOR FURTHER
TREATMENT

11. Examination after
Head Injury ?
Skull X-ray
Neck X-ray
Brain CT Scan
Laboratorium
Courtesy from Neurosurgery department of FKUI RSCM

12. Brain
Hemmorhage
Epidural Hematoma
Subdural Hematoma
Subarachnoid
hemorrhage
Brain membrane
bleeding
Contusions (bruises)
Brain tissue hemorrhage
Fracture
Open skull base
Closed skull base
Skull base fracture
Types of Head Injury

13. Brain membrane Hemmorhage
Drugs
• Reduce Brain Pressure
• Oxygen
Operative
• Blood Evacuation
• Burrhole
• Bone Removal

14. Brain Hemmorhage
Drugs
• Reduce brain pressure
• Oxygen
• Prevent blood clotting
disorders
Operative
• Blood evacuation
• Bone removal
Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A
Review with Focus on the Visual System. Neurol. Int. 2022,14, 453–470.

15. Skull Fracture
Obat-obatan
• Reduce brain pressure
• Oxygen
• Antibiotics
• Prevent blood clotting
disorders
Operasi
• Fracture correction
• Wound cleaning
• Wound suturing
Monheit M. Infant Skull Fracture: Causes, Signs &
Treatment. (2006). Retrieved
from http://caringforspecialneedskids.com/infant-skull-
fracture/

16. Skull Base Fracture
There is fluid/blood
leak from nose
Bed Rest
Meningitis Dose Of
Antibiotics
Reduce Brain
Pressure
https://healthjade.net/battle-sign/

17. WHEN WE DO
CT SCAN?
• MINOR HEAD
INJURY
• MODERATE HEAD
INJURY
• SEVERE HEAD
INJURY

18. THANK YOU