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    Head Trauma: George Ayoub - Med3

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    Joe Khdeir
    Head trauma can range from mild to severe and is a common cause of disability and death. It includes injuries to the scalp, skull, brain, and blood vessels in the head. Concussions involve a brief loss of consciousness while contusions are brain bruises that can cause bleeding. Skull fractures include linear, depressed, diastatic, and basal types. Complications include epidural, subdural, and intracerebral hemorrhages. Treatment depends on the type and severity of injury but may involve surgery, medication, and monitoring of intracranial pressure.

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    Head Trauma: George Ayoub - Med3

    Uploaded by

    Joe Khdeir
    58 views23 pages
    Head trauma can range from mild to severe and is a common cause of disability and death. It includes injuries to the scalp, skull, brain, and blood vessels in the head. Concussions involve a brief loss of consciousness while contusions are brain bruises that can cause bleeding. Skull fractures include linear, depressed, diastatic, and basal types. Complications include epidural, subdural, and intracerebral hemorrhages. Treatment depends on the type and severity of injury but may involve surgery, medication, and monitoring of intracranial pressure.

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    Head Trauma

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    Head trauma can range from mild to severe and is a common cause of disability and death. It includes injuries to the scalp, skull, brain, and blood vessels in the head. Concussions involve a brief loss of consciousness while contusions are brain bruises that can cause bleeding. Skull fractures include linear, depressed, diastatic, and basal types. Complications include epidural, subdural, and intracerebral hemorrhages. Treatment depends on the type and severity of injury but may involve surgery, medication, and monitoring of intracranial pressure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    58 views23 pages

    Head Trauma: George Ayoub - Med3

    Uploaded by

    Joe Khdeir
    Head trauma can range from mild to severe and is a common cause of disability and death. It includes injuries to the scalp, skull, brain, and blood vessels in the head. Concussions involve a brief loss of consciousness while contusions are brain bruises that can cause bleeding. Skull fractures include linear, depressed, diastatic, and basal types. Complications include epidural, subdural, and intracerebral hemorrhages. Treatment depends on the type and severity of injury but may involve surgery, medication, and monitoring of intracranial pressure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    Head Trauma

    George Ayoub – Med3


    Bony structure of the head
    Bony structure of the head
    Blood supply to the head
    What is a head injury
    • broad term that describes a vast array of injuries that occur to the
    scalp, skull, brain, and underlying tissue and blood vessels in the
    head.
    • one of the most common causes of disability and death in adults.
    • can be as mild: GCS 14-15, no amnesia, asymptomatic
    • bump, bruise (contusion), or cut on the head.
    • can be moderate (9-13) to severe (<=8) in nature due to:
    • a concussion, deep cut or open wound, fractured skull bone(s), or from
    internal bleeding and damage to the brain.
    Glasgow coma scale
    Types of head injury
    • Concussion
    • injury to the head area that may cause instant loss of awareness or alertness
    for a few minutes up to a few hours after the traumatic event.
    • Dazed, stunned, headache or pressure sensation, photo/phonophobia,
    speech alteration, disorientation, easy distractibility, repeating answered
    questions, exaggerated emotions, drowsiness, insomnia.
    • Contusion
    • Can be of high (hemorrhagic) or low attenuation areas.
    • Most common in frontal, temporal and occipital lobes (sudden deceleration
    of the head in these areas causes the brain to impact on bony prominences).
    • May progress to frank parenchymal hemorrhages.
    Grading of a concussion
    • Skull fracture; there are four major types:
    • Linear: most common. The break does not move the bone. These patients may be
    observed in the hospital for a brief amount of time, and can usually resume normal
    activities in a few days. Usually, no interventions are necessary
    • Depressed: can be with or without a cut in the scalp. Part of the scalp is sunken in
    from the trauma (comminuted). May require surgical intervention, depending on the
    severity, to help correct the deformity.
    • Diastatic: Occur along the suture lines of the skull. In this type, the normal suture
    lines are widened. Seen in newborn and older infants.
    • Basal skull fracture: Most serious type. Involves a break in the bone at the base of
    the skull. Patients may have a clear fluid draining out of their nose and bruises
    around their eyes (racoon eyes) and behind their ears (battle signs). They require
    close observation in the hospital.
    Coup - contrecoup
    • Contusions can cause coup and contre-coup injuries:
    • Focal brain injuries – occur in a particular spot in the brain.
    • Associated with contusions.
    • Can occur independently or together
    • Occur when the brain collides with the inside of the skull.
    • Coup: under the site of impact with an object.
    • Typical when a moving object impacts a stationary head.
    • Contrecoup: on the side opposite to the area that was hit.
    • When moving head strikes a stationary object.
    • Contrecoup are particularly common in the lower part of the frontal
    lobes and the frontal part of the temporal lobes.
    • It may occur in shaken baby syndrome and motor vehicle accidents causing
    DAI.

    • Coup contrecoup (closed head injury) can damage more than the
    impact sites on the brain
    • Axon bundes may be torn or twisted, blood vessels may rupture and elevated
    ICP can distort the walls of the ventricles.
    Sx w Tx ba3den
    • Intracranial hemorrhage: there are several types classified by their
    location in the brain. Can range from mild to severe and even life
    threatening.
    • Epidural hematoma: blood clot on top of the dura. They usually happen at
    the side of the head due to a skull fracture (baseball to the temple) that shear
    the middle meningeal artery. Diagnosis is made with CT (lens-shaped
    hematoma).
    • Subdural hematoma: blood clot underneath the dura but outside of the
    brain. Diagnosis made with CT (crescent shaped hemorrhage). Can be acute
    or chronic:
    • Acute: in a young person due to a significant amount of force (shaken-baby syndrome).
    • Chronic: in elderly demented patients and alcoholics. Brain atrophy has tensed the
    bridging veins or cortical veins (brain injury) so that even minor trauma can cause
    shearing producing a slowly evolving hematoma.
    • Subarachnoid hemorrhage: trauma is most common cause, also rupture of
    aneurysm (saccular), trauma, arteriovenous malformation. Worst headache of
    my life. Xanthochromic spinal tap.
    • blood breakdown  vasospasm  ischemic hemorrhage: give nemodipine to reduce
    vasospasm.
    • High risk of developing communicative/obstructive hydrocephalus.
    • Anterior communicating artery most commonly ruptured (associated with ADPCKD)
    • Intracerebral hematoma (contrusion): bruise to the brain itself causing
    bleeding and swelling inside the brain around the area where the brain was
    struck. Can be due to fractures or epi/subdural hematoma. When trauma is
    not the cause, it is attributed to long standing HTN in elderly and to bleeding
    disorders in young patients and adults or to the use of medications that cause
    blood thinning.
    • Diffuse axonal injury: happens in angular trauma (spinning in the car stuck on
    an angle) causing blurring in the grey-white matter seen on MRI. Often sited
    as cause of LOC in patients rendered immediately comatose following head
    injury in the absence of a space occupying lesion on CT (although it may
    present with sub/epidural hematomas).
    • Intraparenchymal hemorrhage: in the brain. Causes: systemic HTN, Charcot-
    Bouchard aneurysm (Putamen of basal ganglia), amyloid angiopathy (elderly),
    vasculitis, neoplasm…
    Chronic SDH with
    Subdural hematoma midline shift
    due to fracture

    Epidural hematoma
    Intracranial hemorrhage: Pt
    on warfarin
    Symptoms
    • Epidural: (hyperdense if new – hypodense if old)
    • Loss of consciousness followed by a lucid interval then leading to coma.
    • Herniation syndrome of the uncus: ipsilateral fixed dilated pupil and
    contralateral hemiparesis.
    • subdural:
    • Acute: There is loss of consciousness without lucid interval following MAJOR
    trauma. Neural status from initial trauma not from hematoma.
    • Chronic: gradually deteriorating mental status appearing as dementia, often
    with headache and language difficulty.
    • Intracerebral hematoma (contrusion): bleeding that is sometimes
    spontaneous.
    • Subarachnoid hemorrhage: nuchal rigidity + worst headache of my life.
    • Diffuse axonal injury: symptoms depend on the severity.
    • If severe, hemorrhagic foci occur in the corpus callosum and dorsolateral rostral
    brain stem
    • Axonal retraction balls, microglial stars, degeneration of white matter fiber tracts
    • Diagnosed clinically when LOC >6hrs in absence of evidence of intracranial mass or
    ischemia.
    • Intraparenchymal hemorrhage: neurologic deficits, DAI, carotid artery
    injury.
    Grading of DAI
    • Mild:
    • Coma >6-24hrs followed by mild to moderate memory impairment, mild to
    moderate disabilities
    • Moderate:
    • Coma>24hrs followed by confusion and long-lasting amnesia. Mild to severe
    memory, behavioral and cognitive deficits.
    • Severe:
    • Coma lasting months with flexor and extensor posturing. Cognitive, memory,
    speech, sensorimotor and personality deficits. Dysautonomia may occur.
    Treatment
    • Basilar skull fracture: management of the fracture isn’t as important as
    viewing the cervical spine by CT.
    • Acute epidural hematoma: craniotomy and evacuative procedures
    (excellent results).
    • Acute subdural hematoma: elevation, mannitol and hyperventilation to
    decrease ICP. However, if midline shift (>5mm) is present or <5mm with
    symptoms of herniation, craniotomy is performed.
    • Chronic subdural hematoma: evacuation to relieve symptoms. Seizure
    prophylaxis if post-traumatic seizure (levetiracetam)
    • DAI: little can be done – monitor ICP until they wake up of coma.
    • Subarachnoid hemorrhage: anticonvulsants and observation.
    • Nimodipine for delayed cerebral ischemia neuroprotection.
    • Levertiacetam
    • Triple H therapy: hypertension, induced hyperventilation, hemodilution also used to
    prevent and treat vasospasm. It may cause pulmonary edema, MI, hyponatremia,
    cerebral hemorrhage and edema.
    complications
    • Subdural hematoma treatment:
    • Seizures (status epilepticus  benzodiazepines)
    • ICH
    • Failure of brain to expand
    • Accumulation of fluid
    • Tension pneumocephalus
    • Subdural empyema
    Increased ICP
    • Oxygenation and ventilation
    • Keep PaO2 > 100 and PaCO2 30-35
    • Mannitol reduces cerebral parenchymal cell water but eventually may
    enter CSF and increase ICP.
    • Give Lasix after mannitol to reduce brain bulk during surgery. The
    main mechanism is believed to be due to decreased brain water
    content.
    • Hypertonic saline is also effective in reducing ICP if there is no
    disruption to BBB.
    THANK YOU

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