Head injuries

I -Scalp injuries (stretched skin)

II – Skull.

III- Meninges .

IV- Brain
Infection is dangerous
???why
Cut and contused wounds in the scalp
 What is the problem?
 II -SKULL INJURIES

 Factors governing fractures of the skull:

1- Force
2- Striking surface area( hammer – chair)
3- Position of the head (supported or not)
4- Site of the blow:
The weakest points are the squamous and
temporal bones
- :Types of skull fractures

 1-Skull fractures due to blunt instruments.

Fissure – depressed – comminuted

 2- Skull fractures due to sharp instruments

chipped - cut - cut comminuted
Fissure fracture (linear fracture)-1
- Blunt instrument with wide sticking SA and
low momentum.
 It starts at the point of impact.
 It extends parallel to the line of force.
 The fissure may run into sutures
Fissure fracture (linear fracture) -1

 Multiple blows may produce multiple

fissures, but a second fissure will end
when it reaches the first fissure.

 Fissure fractures may be alone or they

may accompany other types of
fractures.
.Types of Fissure Fracture

 Polar fracture:

 Ring fracture

 Thermal fracture
Depressed fracture-2

 Caused by blunt instrument with small

surface area and medium force
 Depressed localized fractures:
It takes the shape of striking surface
Usually small in size
May be accompanied with fissure fracture
:Depressed comminuted fracture -3

 heavy blunt object having a wide

Surface area and high momentum
 car accidents,
 fall from height.
- :Dangers of depressed fractures

1- Cerebral laceration
2- Intra cranial hemorrhage.
3- Cerebral compression.
4- Intracranial infection.
5- Subjecting the patients to a
decompression operation, this leaves
a bony gap and permanent infirmity.
Skull fractures due to sharp instruments-2

A- Sharp and light instrument e.g. knife

 Cut fracture
 Chipped F tangentially causing removal
of the outer table.

B- Sharp and heavy instruments

 Injuries produced by an axe

1- The blade of an axe  cut fracture.

2-If the blade passes tangential to the outer table;
chipped F
3- The cut may be triangular if the striking is done
with angle
4-The striking with the head of the axe
localized DF.
5- The handle of the axe fissure fractures.
FRACTURES OF THE BASE

 These are usually fissure fractures

 Fracture Anterior fossa  eye
 Fracture Middle fossa  ear
 Fracture posterior fossa  neck
HEALING OF SKULL FRACTURES
A- Healing of fissure fracture
1. The edges are glued by serous exudates in one week
2. Smoothening of the edges in about 2-3 weeks
3. Complete closure with osseous in 3-4 months

B- Healing of depressed / comminuted

fracture (no bone)
C- Healing of cut fractures. As those of
fissure fractures
Sepsis
Appears in the skull in the form of bone
erosion affecting either the outer, inner or
both tables within 4-6 weeks. Bone erosion
indicates that the cause of death is possibly
septic intracranial complications -
meningitis, brain abscess or sinus
thrombosis
III- INJURIES TO MENINGES
1- Extradural hemorrhage (Traumatic)
2- Subdural hemorrhage
* Traumatic → A- acute
B-Chronic (pachymeningitis haemorrhagica )
* Pathological (hypertension- Blood Disease ---)
3- Subarachnoid hemorrhage:
4- Intracerebral hemorrhage:
A- Traumatic: Coup injury or Contre-coup
B- Pathological
IV- BRAIN INJURIES

A- CONCUSSION :
* Definition
* C/P
* Fate of concussion
1- Complete uncomplicated recovery
2- Death
3- Compression
Lucid interval
 Definition:

 Mechanism :

 Medico legal importance

 Treatment of concussion :
observation. No morphine
B- COMPRESSION
 Definition
 Mechanism Stage of irritation Stage of paralysis
 Clinical picture : Victim is conscious 
gradually  drowsiness  blurring of
vision  severe headache (mainly
occipital). Then- Fever effortless
central vomiting High blood
pressure  slow full pulse  coma 
death
Causes of cerebral compression

1- Intracranial hemorrhage.
2- Pressure by fragments of bone

Treatment of compression
 The following are lateralizing signs of
compression, which are diagnostic to the
:compressed side

On the side of hemorrhage

 The pupils are unequal constricted (more on affected side)
 Conjugate deviation of both eyes
On the opposite side
 Exaggerated reflex of the other side
 Hemiplegia occurs on the contra lateral side
C- brain contusion
d- brain laceration
Both contusion and laceration can occur in cases
.of coup or contre-coup lesion
Differences between concussion and
compression
 Mechanism
 Loss of consciousness
 Pulse
 BP
 Reflexes
 Vomiting
 Pupils
 Signs of lateralization
 Treatment
SEQULLAE & COMPLICATIONS OF HI

1- Post traumatic amnesia or retrograde amnesia

2- Post traumatic automation
3- Post traumatic neurosis
4- Korsakoff's psychosis
5- Personality changes:
6- Jacksonian epilepsy
7-Septic complications
8-Permanent infirmity