Head Injury Lect 5

Head Injury
Pathomechanics of brain Injury

When the head strikes a fixed object, the coup injury
occurs beneath the point of cranial impact.
The counter coup injury occurs at the opposite side of
cranial impact as the brain rebounds within the
cranium.
Rotational Injury
Type of skull Fracture
Type of brain injuries
Diffuse brain injuries
Focal Brain injuries
Diffuse brain injuries
Structural diffuse brain injury
Cerebral concussion
Structural Diffuse Brain Injury
Structural diffuse brain injury (diffuse axonal injury, or
DAI) is the most severe type of diffuse injury because
axonal disruption occurs.
 Typically resulting in disturbance of cognitive
functions, such as concentration and memory.
DAI can disrupt the brain stem centres responsible for
breathing, heart rate, and wakefulness.
Cerebral concussion or Mild diffuse injury
The most common sport-related TBI and is often
referred to as mild traumatic brain injury (MTBI).
Headache, nausea, vomiting, dizziness, balance
problems, feeling “slowed down,” fatigue, trouble
sleeping, drowsiness sensitivity to light or noise, loss
of consciousness, blurred Vision, difficulty
remembering, or difficulty concentrating.
Cerebral concussion or Mild diffuse injury
An immediate and short lived functional neurological
impairment
Concussion is most often associated with normal
results on conventional neuroimaging studies, such as
MRI or CT scan.
Type of cerebral concussion
Mild
Moderate
Severe
Types of concussion
Types of concussion
Post concussion syndrome historically called shell
shock, is a set of symptoms that may continue for
weeks, months, or occasionally a year or more after
a concussion.
“No athlete should be returned to participation while
still experiencing symptoms”
Focal Brain Injuries
1) Focal vascular Injury
Subdural hematomas
Intracerebral hemorrhages
Epidural hematomas
2) Cerebral contusions
Signs and Symptoms of Focal
Vascular Emergencies
• Loss of consciousness
• Cranial-nerve deficits
• Mental-status deterioration
• Worsening symptoms
Cerebral Contusion
The brain substance may suffer a cerebral contusion
(bruising) when an object hits the skull or vice versa.
The impact causes injured vessels to bleed internally

and there is a concomitant loss of consciousness.
Cerebral Contusion
A cerebral contusion may be associated with partial
paralysis or hemiplegia (paralysis of one side of the
body), one-sided pupil dilation, or altered vital signs
and may last for a prolonged period.
Even severe contusions recovery occurs without inter-
cranial surgery.
The prognosis is often determined by the supportive
care delivered from the moment of injury, including
adequate ventilation and cardiopulmonary
resuscitation if necessary.
Cerebral Hematoma
Epidural
Subdural
Intracerebral
Epidural
Severe blow to head; skull fracture
The epidural hematoma involves an accumulation of
blood between the dura mater and the inner surface of
the skull as a result of an arterial bleed—Middle
meningeal artery
Typically produces a skull fracture in the
temporoparietal region.
Neurological status deteriorates in 10 min–2 hr
Transport and expert evaluation
Immediate surgery may be required
Epidural
An altered state of consciousness
Lucid interval
“The problem arises when the injury leads to a slow

accumulation of blood in the epidural space, causing
the athlete to appear asymptomatic (lucid) until the
hematoma reaches a critically large size and begins to
compress the underlying brain.”
Subdural
Force of blow thrusts brain against point of impact
Subdural vessels tear and result in venous bleeding
Neurological status deteriorates in hours, days, or
weeks
Intracerebral
Depressed skull fracture, penetrating wound,
acceleration–deceleration injury
Torn artery bleeds within brain substance
A heterogenous zone of brain damage that consists of
hemorrhage, cerebral infarction, necrosis, and edema
Intracerebral hematomas are similar in
pathophysiology and imaging appearance to a cerebral
contusion.
Rapid deterioration of neurologic status
Second impact syndrome (SIS)
Sustains second injury before symptoms from first
injury resolve
Brain loses auto regulation of blood supply; rapidly
swells and herniates
Typically occurs within 1 wk of first injury
Pupils rapidly dilate, loss of eye movement,
respiratory failure, eventual coma

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Head Injury

Pathomechanics of brain Injury

The impact causes injured vessels to bleed internally

“The problem arises when the injury leads to a slow

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