1. Head trauma can cause various injuries including scalp lacerations, skull fractures, and intracranial hematomas such as extradural, subdural, and subarachnoid hemorrhages. 2. Extradural hematomas require emergent neurosurgery due to risk of neurological decline from mass effect. Subdural hematomas are often chronic in elderly patients and may expand due to osmotic pressure. 3. Aneurysmal subarachnoid hemorrhage has identifiable risk factors and presents with thunderclap headache, often requiring cerebral angiography for diagnosis and treatment.

1. Head Trauma
Waqar Saeed
Group B

2. PhysiologyPhysiology
• Continuous blood flow of oxygen and glucose.
• Normal cerebral blood flow (CBF) is about 55mL/min per 100g
of brain tissue.
• Rate below 20mL/min can result into ischemia and infarction.
• CPP = MAP – ICP
• MAP (90-110mmHg)
• ICP (5-15mmHg)

3. Cerebral Perfusion PressureCerebral Perfusion Pressure
• Net pressure of blood delivery to the brain.
• In a normal adult, CPP is generally regulated between 75 and 105
mmHg (can be more or less).
• Cerebral autoregulation.
• Most common pathophysiologic pathway is elevated ICP.

4. Monro Kellie DoctrineMonro Kellie Doctrine
• The brain is protected by a rigid case, within which there is no
“extra” space.
• Skull (holds three things)
Brain
Blood
Cerebro-Spinal Fluid (CSF)
• An increase in any one of these three “compartments” displaces
the other two.
• Only small volume increases can be tolerated before intracranial
pressure (ICP) begins to rise.

6. EpidemiologyEpidemiology
• 3-4% of ER attendances
• 1500 cases per 100,000 population per year in UK.
• Leading cause of death and disability from childhood to early
middle age.

8. Mechanisms of InjuryMechanisms of Injury
• Motor vehicle crashes
• Sports Injuries
• Falls
• Penetrating trauma

9. Categories of injuryCategories of injury
• Coup injury
• Countrecoup injury
• Diffuse Axonal injury
• Focal injury

13. ClassificationClassification

14. Primary Evaluation andPrimary Evaluation and
ManagementManagement
• Resuscitation according to ATLS guidelines.
• History
• Pupil Responsiveness
• Glasgow Coma Scale

17. Glasgow Coma ScaleGlasgow Coma Scale

19. • A 29-year-old woman was an unbelted passenger in a motor
vehicle accident. On arrival to the hospital, the paramedics
inform you that she opens her eyes in response to verbal stimuli.
She is incoherent and withdraws from painful stimuli. Which of
the following is the patient’s calculated Glasgow Coma Scale
(GCS)?
• a.15
• b.3
• c.9
• d.5
• e.12

20. Primary InjuryPrimary Injury
• Induced by mechanical force and occurs at the moment of injury
• Causes: Impact, Mechanical disruption of cells, Vascular
permeability or disruption,

21. Head InjuriesHead Injuries
• Subgaleal hematoma

22. Scalp lacerationsScalp lacerations

23. Skull base fracturesSkull base fractures

24. Intracranial HaematomaIntracranial Haematoma

25. Case ScenarioCase Scenario
• A 15 year old boy was hit with a baseball on his head and he
became unconscious. After about ten minutes, he regained
consciousness, but he soon became lethargic, and over the next
two hours, he was stuporous. His pupils were unequal. He was
shifted to the radiology department for an urgent CT scan, which
is shown

27. Extradural hematomaExtradural hematoma
• Neurosurgical emergency
• Young population
• Rupture of middle meningeal artery
• Lucid interval with headache
• Ipsilateral pupillary dilatation and reduced consciousness

28. ManagementManagement
• Stabilize acute life-threatening conditions and initiate supportive
therapy. Airway control and blood pressure support are the most
important issues.
• Establish IV access, administer oxygen, and monitor.
• Administer IV crystalloids to maintain adequate blood pressure.
• Intubation, sedation, and neuromuscular blockade per protocol. There
is some suggestion of increased mortality with prehospital intubation in
retrospective reviews of trauma patients with moderate-to-severe head
injury compared with patients intubated in the ED. Bag-valve-mask
ventilation with good technique may be of more benefit to brain
injured patients than prehospital intubation.

29. Acute Subdural HematomaAcute Subdural Hematoma
• High energy Injury mechanism
• Conscious level impaired
at presentation
• CT scan

30. Chronic Subdural HematomaChronic Subdural Hematoma
• antiplatelet and anticoagulant medications
• Cerebral atrophy in elderly stretch the bridging veins.
• Rupture after only minor trauma
• Degradation of clot leads to osmotic expansion
• Mass effect

31. SymptomsSymptoms
• Expanding intracranial mass
• Pressure symptoms i.e headache, drowsiness, neurological deficit,
seizures.
• Electrolyte imbalance and infections may be contributory

32. ManagementManagement
• Burrhole procedure under local LA
• If clinically stable, a delay of 7-10
days to allow platelet function to
normalize after withdrawal of aspirin
• Anticoagulation should be reversed by administration of Vit K

33. Aneurysmal SubarachnoidAneurysmal Subarachnoid
HemorrhageHemorrhage
• Berry Aneurysms develop at the branch points.
• Incidence of 10-15 per 100,000 population per year.
• Risk Factors, Age, Female gender, Hypertension, Smoking,
Cocaine abuse and Family history of two first degree relatives.
• Genetic disorders.

35. Clinical featuresClinical features
• Neck pain or stiffness
• Loss of consciousness
• Onset of headache during exertion
• Thunderclap headache
• Limited neck flexion

36. InvestigationsInvestigations
• CT Scan

37. Cerebral AngiographyCerebral Angiography

38. Prevention of SecondaryPrevention of Secondary
InjuryInjury

40. • Seizures
• Nutrition