Traumatic Brain injury.docx

1. Traumatic Brain injury (TBI)
Mechanism of injury :-
Indirect
-Traffic accident
-Rolahenal injury
-Deformity injury
-Brain coatussion
-Coup injuries
-Contro-Coup
-Mostly in Occipital and frontal Lobe.
Direct
-Guns
Types of injury:-
Primary :-
-Scalp Laceration . : External vascular
Tends to bleed prefusoly
Treat hemostasis (compression,suture) wound closure
-Skull fructures (Liner , Basilar , Depressed)
Liner common .no complication or surgical intervention
Heal spntanusly
Problems – ckowing fractures
Diastatic
Depressed Fracture :-
Serious surgical interrenation (hemostasis , debridement )
Dural Rebair and evaluation of bone fracture
Dura matter septure
Basilar Fracture :-
- Serious case of skull deformity
- Sign depend on the site of injury :-
1) anterior fossa , Rhinerrhoea
- Loss of smell

2. - Raccon’s eyes , periorbital
2) Middle fossa
-Otorrhea
-Battles sign
-Vertigo
3) Posterior Fossa
-signs of brainstem
-Compression
-Concussion (mild , traumatic brain injury)
Amnesia . loss of conscionsness
Take few months of resolve
No morphological abnormality (CT , MRI , CSF )
It is clinical diagnostic
-Cerebral contusion
Diformity of brain tissue
Mostly occure in frontal and temporal labes
Can be multiply or bilateral
Hemorrhage ,edema
Complications:-
-Hemorrhage and hematoma
-Hematoma – (A) Epidural Hematoma ( between duramatter and and skull )
-Pterigoid region
-Middle meniseal artery bleeding
-Herniation

3. Treatment :- (for epidural)
-Surgical evacuation
-Craniotomy
Clinical signs : CT –Brain
(B) Subdural hematoma
-Between dura mater and subarchnoid space
-acute (24 h – 48h)
-Sub acute (2days – 2 weeks)
-Chronic (2 weeks – 3 weeks )
-Treatment : Surgecal evacuation , Craniotomy .
(C) Subarachnoid hematoma
--No brain compression
-No bleed collection
(D) Intracrainal hematoma
-Depressed fractures
-penetrating injury
-Acceralration , Deccelaration , injury accident
-Rupture of aneurysm , hemorrhagic , Strock
-Axial / Extra.Axial –Hematoma

4. -Diffuse axonal injury:-
Rare and serious [seen in MRI]
Rotation force [seen in MRI]
Accidents [seen in MRI]
Neuronal treating
White matter
Suspect if any cerebral contusion on CT
Coma 26 hours (signs of hematoma intracranial )
Cushing sign
Conta lateral hemporesis hemeplastn
Bratycharin
CT Scan
Intracranial Pressure:-
Symptoms:-
-Confussion
-Drowness
-Headache
-Seizures
-Nausia
-Vomiting
-Blussed vision
-Popilla edema
-Weakness on one side of the body
-Change in papolary response

5. **In pediatrics : Pesitant crying and refuse to eat **
**Increase intracranial pressure lead to Decrease cerebral perfusion pressure causing ischemia **
**Midline shift causing ventricular obstruction
**Herniation **
Glasgow Coma Scalp :-
-Max 15
-Minimum 3
-Min GCS 13 – 15
-Moderate GCS less than 8
-Eye movment
-Verbal respons
-Motor respons
Neurological exam :-
-Most important method management ABCD , Airway , Breathing , Circulation , Disability .
Measurement of ICP :-
-Sub arachnoid (seria)
-Epidural tran
-Subarachnoid catheter
-Fibeobtic device
-Ventricula stemy catheter