HEAD INJURIES

KANWAL KHAN
SENIOR LECTURER
ZCPT
H ead Injuries

A sudden trauma
that damages
brain and
disrupts normal
brain function.
In N ationalCenter for
injury prevention &
controlU SA
1 person suffers
from TBI in every
16 seconds.
Up to 1.4 million
people sustain a
TBI
Brain Injuries

Excessive Force,
Blow
Penetrating Injury
Falls
Vehicle Accidents
Struck Against
Objects
 Biom echanics
O fBrain Injuries
Collision of head
with an appreciable
velocity.
Sudden motion due
to impulsive load
without contact.
Static-Quasistatic
loading.
AllInjuries O ccur due to
Strains
Any contact or inertial force produces appreciable strain
beyond tissue tolerance.
Compressive strains
Tensile strain
Shear strain
Brain and vessels got injured at 10-20% strain.
 Pattern O fInjury
Injuries Due To Translational
Focal
Acceleration

Contact Forces
Contact Forces &
TranslationalAcceleration
Causes
Skull fractures.
Epidural
heamatoma.
Coup-Counter
Coup Contusion.
Intracerebral
Heamatomas.
Subdural
heamatoma.
 Contact & Translational
Forces

Depressed Fractures

Fracture
With
Brain Laceration
Vertigo In SkullFractures
 TranslationalAcceleration And
Contact Forces

Coup-Counter Coup

Blow

Heamatomas
EpiduralH eam atom a
SubduralH em atom a
Coup-Counter Coup Contusion
Pattern O fInjury

Due To Rotational
Acceleration
Diffuse Injuries

Inertial Forces
Rotational& Inertial
Forces Causes
Concussion
Diffuse Axonal Injury
Sub-arachnoid
Heamrrohages
Intraventricular
Hemorrhages
Gliding Contusions
Tissue Tear
Heamrrohages
 RotationalAcceleration
& InertialForces

Contusions

Concussion
D iff
use AxonalInjury D AI

Grade I: DAI mainly in parasagital

white matter of cerebral
hemispheres.

Grade II: grade I + Lesions in Corpus

Callosum

Grade III: grade II + Focal injury of

lobes.
D iff
erence b/w Focal& D iff
use
Injuries
Diffuse Axonal Injury or rotational
movements results in LOC.

Focal injuries or translational injuries

will not result LOC.
Penetrating/O pen
H ead Injury
In which dura
matter and outer
layer of meninges
breached.
Gunshot high
velocity After Gunshot
projectiles such
as knives etc.
 H ypoxic Ischem ic Injury
Lack of oxygenated
blood flow.
Systemic
hypotension,
anoxia, or damage
to specific vessel.
Poor co-ordination
and judgment
Extreme Lethargy
Severe oxygen
deprivation
H erniation Syndrom es
Cistern O bliteration
Supratentorial
brain herniation
occurs in three
patterns:
Subfalcine
Central
Transtentorial
Uncal
 Subfalcine H erniation
Most Common
Compresses the
ACA and possible
ischemia of
parietal & frontal
lobes.
Present with
abnormal
posturing and
coma.
CentralTranstentorial

Caused by mass
lesion
Involve frontal,
parietal and
occipital lobes.
Presents
agitation,
drowsiness &
impaired upward
gaze.
U ncalH erniation

Lesions in lateral
middle fossa or
temporal lobe.
Compress ipsilateral
PCA and cerebral
peduncle & stretch
of occulomotor
nerve.
Presents contralteral
hemiparesis,
decreased
consciousness,
same side dilated
 Second Im pact Syndrom e
A special condition involves that of second impact
syndrome (SIS).
SIS occurs when an athlete who has sustained an initial
head trauma, most often a concussion, sustains a
second injury before symptoms associated with the
first have totally resolved.

Often, the first injury was unreported or unrecognized.

SIS usually occurs within 1 week of the initial injury and

involves rapid brain swelling and herniation as a result
of the brain losing autoregulation of its blood supply.

Brain stem failure develops in 2 to 5 minutes, causing

rapidly dilating pupils, loss of eye movement,
respiratory failure, and eventually coma.
SpecialTests for A ssessm ent of Cognition
Im pairm ents & D efi
cits
O fBrain Injuries
Neuromuscular
Cognitive ,
Executive
Function
Behavioral
Visual-perceptual
Swallowing
Speech.
Two types of global brain injury include:
A. Small and large
B. Simple and complicated
C. Focal and diffuse
D. Uncomplicated and complex
E. Mild and severe
If an athlete loses consciousness following a
sport related concussion:
A.He or she should be allowed to return to play
that day
B. He or she should see the team physician
C.He or she should be allowed to return whenever
ready
D. None of the above
E. All of the above
Headache following a concussion:
A. Is a minor detail
B. Can be an indication of whether the injury is
improving or worsening over time
C. Should not be considered when making a return
to-play decision
D. It not a common symptom
E. None of the above
Which of the following are key elements
of injury mechanisms for cerebral
concussion?
A.Velocity of head before impact
B. Time over which force is applied
C.Magnitude of force
D. None of the above
E. All of the above
E. Both A and C
During the secondary survey, the clinician
should attempt to gain as much information
about all of the following except:
A.Mental confusion
B. Loss of consciousness
C. History (including mechanism of injury)
D. Amnesia
E. All include information the clinician should
obtain.
An epidural hematoma is:
A. A venous bleed
B. A subarachnoid bleed
C. An arterial bleed
D. An intracerebral bleed
E. None of the above