Traumatic Head Injuries PDF

Traumatic head injuries Dr. Reem Khaled Content 01 Scalp 02 Skull 03 Brain 04 Intracranial hemorrhages  01 Scalp Scalp injuries 1) Bruises or contusions of the scalp 2) Contused wound: most common 3) Incised wound....

Traumatic head injuries Dr. Reem Khaled Content 01 Scalp 02 Skull 03 Brain 04 Intracranial hemorrhages  01 Scalp Scalp injuries 1) Bruises or contusions of the scalp 2) Contused wound: most common 3) Incised wound. 4) Firearm injuries. Scalp injuries Complications: 1) Severe bleeding: Rich blood supply, leathery texture 2) Intracranial infection. 3) Tetanus.  02 Skull  Skull injuries Vault fracture Blunt striking surface Sharp striking surface wide localized Cut fracture Considerable Low High amount of Very high momentum+ momentum momentum momentum pointed end instrument Fissure Comminuted Localized depressed Penetrating  Fissure fracture Linear Causative instrument Diastatic  Comminuted Mosaic fracture fracture Spider web fracture Cracked egg fracture Localized depressed fracture Signature fracture Penetrating fracture Cut fracture Basal skull fractures Ring fracture Cause? Type? 03 Brain  Brain injuries Contusions Concussion and lacerations Compression  Brain concussion Definition: It is a clinical state of sudden momentary loss of consciousness following head injuries. Mechanism  Clinical picture 1. Loss of consciousness (the patient falls to the ground), it ranges from seconds up to few minutes. 2. Low blood pressure with weak rapid pulse (V.M.C). 3. Shallow rapid respiration. 4. Subnormal temperature. 5. Skin is pale, moist and cold (V.C.C). 6. Equal pupils. 7. Vomiting is a common symptom (due to rotational movement of the brain). 8. Muscles are flaccid with loss of reflexes. The last reflex to disappear and the first to reappear is the corneal reflex followed by sphincter reflex. Fate of cerebral concussion: 01 Complete recovery 02 Incomplete recovery 03 Compression with lucid interval 04 Compression without lucid interval Lucid interval Definition: It is the period of temporary recovery between the unconsciousness state of concussion and that of compression. The patient may be able to walk to home unaided, speak sensibly and tell the events. Cause: It is common with injury of the middle meningeal artery or one of its branches (extradural hemorrhage). Duration: Few minutes, hours, or even few days according to the size of ruptured vessel. Lucid interval: Medicolegal importance ? Patient Doctor Defense Say the name of Keep the patient Claims that the blow is not assailant 24 to 36 hours the cause of death Compression  Cerebral compression Definition: It is a clinical condition caused by increased intracranial pressure (inside the rigid boundaries of the skull) which disturbs functions of the brain, leading to gradual loss of consciousness.  Cerebral compression Mechanism: Cerebral compression passes through 2 phases: 1. First phase: Stage of irritation: Gradual accumulation of blood will press firstly on cerebral veins, leading to cerebral congestion and edema. This leads to cerebral irritation of higher centers on the side of cerebral lesions. 1. Second phase: Stage of paralysis: Haematoma will compress the cerebral arteries. This leads to cerebral ischaemia and paralysis of higher centers on the same side of the lesion. Clinical picture: 1. Gradual loss of consciousness: 2. Rigidity of muscles of the back of the neck 3. Rising blood pressure due to irritation stage of vasomotor center, later on it is dropping due to paralysis of the same center. 4. Pulse: Slow and full pulse due to stimulation of vagal center. 5. Respiration: Slow and deep respiration due to the starting depression of respiratory center Then, stertorous due to movement of the flaccid soft palate and falling back of the tongue. Lastly, irregular and chyne-stockes breathing with severe depression of respiratory centre. 6. Temperature: increased in the late stage due to paralysis of the heat-regulating center (especially heat loss). Signs of lateralization: (on the same side of the lesion) Pupils: are unequal. Constricted pupil of the same side of compression then followed by dilatation due to paralysis. The other pupil follows in the same order (constriction then dilatation), Terminally, both pupils are dilated and fixed. Conjugate deviation of both eyes to the side of the lesion due to irritation of its center, then to the other side. Muscles: (starting from the contralateral side as 80% of motor fibers cross to opposite side) ❑ Exaggerated reflexes then lost ❑ Muscle twitches then paralysis Signs of lateralization: (on the same side of the lesion) Pupils: are unequal. Constricted pupil of the same side of compression then followed by dilatation due to paralysis. The other pupil follows in the same order (constriction then dilatation), Terminally, both pupils are dilated and fixed. Conjugate deviation of both eyes to the side of the lesion due to irritation of its center, then to the other side. Muscles: (starting from the contralateral side as 80% of motor fibers cross to opposite side) ❑ Exaggerated reflexes then lost ❑ Muscle twitches then paralysis Extradural Subarachnoid Subdural Dura Arachnoid Pia Intracerebral Thanks