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NEUROLOGIC TRAUMA
I.HEAD INJURIES
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Includes injury to the scalp, skull, or brain
Pathophysiology
 Primary Injury
– The initial damage to the brain that results from traumaticevents. (Contusions, lacerations, torn blood vessels from impact, foreign object penetration.)
 Secondary Injury
– An insult to the brain subsequent to the original traumaticevent
Head InjuryIncrease intracranial volumeIncrease ICPDisplacement of the brain against rigid structure of the skullRestriction of blood flowIschemia / InfarctionCerebral blood flow ceasesBrain Death
 
A.Scalp Injury
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A minor head injury
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Trauma may result in abrasion, contusion, laceration, or hematoma beneaththe layers of tissue of scalp
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The area is irrigated before laceration is sutured to remove foreign materialsand to remove foreign infections
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 Subgaleal Hematoma – 
Hematomas below the outer covering of the skull
B.Skull Fractures
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A break in the continuity of the skull caused by forceful trauma
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May occur with or without damage to the brain
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Classified as:
linear, comminuted, depressed, basilar 
Clinical Manifestations
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 Battle’s sign
 – An area of bruising may be seen over the mastoid
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CSF otorrhea
– CSF escapes from the ears (suspected of basal skull fractures)
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CSF rhinorrhea
– CSF escapes from nose
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 Halo sign
– Blood stain surrounded by a yellowish stain (suggestive of CSFleak)
Assessment and Diagnostic Findings
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CT scan – can detect less apparent abnormalities
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MRI – produces more accurate picture of the anatomic nature of the injury
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Cerebral Angiography- identifies supratentorial, extracerebral, andintracerebral hematomas and cerebral contusions
Medical Managements
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After the skull fragments are elevated, the area is debrided
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Large defects can be repaired immediately with bone or artificial grafts
 
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 Nasopharynx and external ear should be kept clean (to asses CSF leakage)
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The head is elevated 30 degrees
II.BRAIN INJURY
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Close (blunt) brain injury
– occurs when the head accelerates and thenrapidly decelerates or collides with another object and brain tissue is damaged, but there is no opening through the skull and dura
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Open brain injury
– occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path (penetrating injury), or when blunt trauma to the head is so severe that it opens the scalp, skull anddura to expose the brainA.
Concussion
- A temporary loss of neurologic functions with no apparentstructural damage to the brain
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“
 Seeing stars
” – jarring of the brain cause dizziness and spots before theeyes
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If 
 frontal lobe
is affected – bizarre, irrational behavior 
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If 
Temporal lobe
– temporary amnesia or disorientation
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Observe patient for 
 postconcussion syndrome
such as headache, dizziness,lethargy irritability, and anxietyB.
Contusion
- Bruising of the brain surface with possible surface hemorrhage
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Often there is involuntary evacuation of the bowels and the bladder.
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Patient may be aroused with effort but soon slips back intounconsciousnessC.
Diffuse Axonal Injury
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Involves widespread damage to axons in the cerebral hemispheres, corpuscallosum, and brain stem
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