Head Injuries PDF

Head Injuries  Head Injuries The high incidence :- ▪ The head is the target of choice ▪ When the victim is pushed or knocked to the ground, he often strikes his head. ▪ The brain and its coverings are vulnerable to degrees of blunt trauma that would rarely be lethal if...

Head Injuries  Head Injuries The high incidence :- ▪ The head is the target of choice ▪ When the victim is pushed or knocked to the ground, he often strikes his head. ▪ The brain and its coverings are vulnerable to degrees of blunt trauma that would rarely be lethal if applied to other areas. ▪ Head injuries for easiness discussed under three headings: ▪ Scalp injuries. ▪ Skull injuries. ▪ Brain injuries. ▪ Scalp Injuries:- the Scalp is the outermost covering of the head and it has five layers from out side to inwards: ▪ Skin ▪ connective tissue ▪ galae aponeurotica( epicranial aponeurosis) aponeurosis of the occipito frontalis muscle. ▪ loose areolor tissue ▪ pericranium. Injuries include: ▪ Abrasions ▪ Contusions – Black eye due to bleeding into the soft tissue caused by : ▪ A direct blow into the orbit. ▪ An injury to upper front of the scalp. ▪ A fracture of base of the skull : ▪ anterior cranial fossa ▪ membranous bone of the orbit roof. ▪ Skull Injuries:- Skull is a diploic bone having an outer table and inner table. The outer table is thicker and stronger, while the inner table is thinner and weaker. A spongy bone is in between giving elasticity to the bone. ( 2 types of bone – cancellous, trabecular, spongy unit trabecula _ compact, cortical bone unit osteon including Haversian and Volkman canals.) 2 types: ▪ fracture of the vault of the skull. ▪ fracture of the base of the skull. Vault Fractures:- ▪ Fissured fracture:- (Linear fracture) involving only outer or inner table or both. ▪ Stellate Fracture:- (Radiating fracture) comminuted fracture with fracture fragments held intact. ▪ Mosaic Fracture:- (Spider’s web fracture) comminuted depressed fracture with tissues radiating from it forming a spider’s web. ▪ Depressed Fracture:- (Signature fracture) the fractured bone fragments are driven inwards and it may correspond in size, shape to the causative weapon. ▪ Elevated Fracture:- One end of the fractured fragment is elevated above the surface of the skull while the other dip down into the cranial cavity and injure the dura mater of brain directly. ▪ Diastic Fracture :- (Diastasis, suture line fracture) fracture occurring along the skull sutures, occurs in children and young person. ▪ Gutter Fracture: thickness of the skull bone is affected leading to an irregular depressed fracture of the inner table. ▪ Comminuted Fracture:- (Crushed fracture) the bone is broken into pieces. ▪ Fractures of Base of the Skull:- Characterized by escape of blood and CSF through the nose, ears and back of the neck corresponding to anterior, middle and posterior cranial fossa fractures. ▪ Ring Fracture:- (Around the foramen magnum) due to fall and landing on the crown of the head. ▪ Hinge Fracture:- (Motorcyclist’s fracture) fracture of the base of the skull, the fracture line runs from side to side across the floor of the middle cranial fossa and through the pituitary fossa. Brain Injuries and Intracranial Haemorrhage:- ▪ Cerebral concussion “ a condition where there is a temporary derangement of the neuronal activity without demonstrable organic lesion in the brain.” Clinically ▪ loss of consciousness ▪ flaccidity of muscles ▪ followed by recovery of the consciousness leading to loss of consciousness again. ▪ Concussion followed by: Post Concussion Syndrome: Headache, dizziness, nervousness and epilepsy. ▪ Lucid Interval:- The period of recovered consciousness between two bouts of unconsciousness, mentally a person is found to be perfectly normal during this phase. Extradual Haemorrhage (EDH):- Bleeding outside the dura mater ▪ Causes:- ▪ Commoner due to fracture of the temporal bone and rupture middle meningeal artery. ▪ fracture of the frontal bone, occuipital bone and vault. ▪ Collected blood leads to pressure effects and displacement of the brain, increased ICP, loss of consciousness and coma (in few hours or days). Extraduarl haematoma ▪ Findings:- ▪ Ipsilateral dilated pupil. ▪ Contralatral paresis. ▪ Lucid interval. ▪ Automatic movements. ▪ May be confused for alcoholic intoxication and the victim may be put in custody under the charge of drunkenness. Subdural Haemorrhage (SDH):- Subdural space has no mesothelial lining, haemorrhage can not get resolved, it leads to formation of a blood cyst. Common in children and old people. ▪ Causes:- ▪ Gliding movement between dura and arachoid mater ▪ bruices and lacerations of the brain. ▪ Minor trauma like sudden jerky movement of head (in old people leading to bilateral subdural haemorrhage) ▪ Usually it is incidental in nature, with no manifestations for long time apart of slight confusion forgetfulness emotional disturbance. It is mistaken for: schizophrenia in young victims presenile or senile dementia in old people. Subarachnoid Haemorrhage (SAH):- Causes:- ▪ All traumatic causes ▪ Prolonged hyperextension of the neck. ▪ Diseases like atheroschlerosis, hypertension or leukaemia. ▪ Berry aneurysms of basilar artery. ▪ Manifested by sudden loss of consciousness. ▪ No haematoma formation, blood removed by lysis or phagocytosis. Spinal Cord Injuries:- Basically four types: ▪ Concussion Whiplash injury: hyperextension followed by hyper flexion as in rear impact in car accidents. It leads to dislocation at C4-C6 with haemorrhage in spinal cord substance. Leads to quadriplegia. ▪ Compression of the spinal cord – in fracture dislocation C4-C6, T3-T6, T10-L3 in Pott’s disease. ▪ Pithing: killing by pushing a fine needle into the nape of the neck between base of skull and first cervical vertebrae. ▪ Laceration of the spinal cord. twisting of the neck accompanied with laceration without evident external injury as in infanticide, wresting.