Professional Documents
Culture Documents
ON
HEAD INJURY
AND MANAGEMENT OF
UNCONSCIOUS PATIENT
Presented by:
Daka Lamare,
1st year M.Sc. (N)
RIMS, CON, Manipur
ANATOMY OF THE HEAD
ANATOMY OF THE BRAIN
INTRODUCTION
o Head injury is a general term used to describe any trauma to the head
and most specifically to the brain itself.
oMotor vehicle collisions and falls are the most common causes of
head injuries. It has a high potential for a poor outcome.
oDeaths from head trauma occur at three points after injury:
1. Immediately after the injury.
2. Within 2 hours after the injury.
3. Approximate 3 weeks after injury.
INTRODUCTION
oDeaths occurring 3 weeks or more after the injury results
from multisystem failure.
oThe GCS score on arrival at the hospital is also a strong
predictor of survival.
oGCS below 8 indicates a 30% – 70% chance of survival.
oGCS above 8 indicates a greater than 90% survival rate.
DEFINITION
oHead injury includes any injury of trauma to the brain, scalp, or skull.
oA serious form of head injury is traumatic brain injury (TBI).
oTBI is defined as disruption of brain function resulting from a blow or
jolt to the head or penetrating head injury
oDamage to the brain from traumatic injury takes two forms: primary
injury (due to initial damage such as damage to scalp, blood vessels, or
foreign body penetration) and secondary injury (evolve after initial
damage such as cerebral edema, increase ICP, ischemia or electrolyte
disturbances)
MECHANISM OF HEAD INJURY
Acceleration injury: Occurs when a moving object strikes a non-
moving object. E.g., a missile fired into a head
Deceleration injury: Occurs when a moving head strikes a stationary
object such as in a fall
Acceleration – deceleration injury: It results from unrestricted and
sudden head movement. E.g., a motor vehicle suddenly decelerates
wand the head hit an immobile object such as the steering wheel.
Penetration injury: Occurs when an object enters the skull and harms
the brain
MECHANISM OF HEAD INJURY
Whiplash injury: A neck injury that can occur when the head
suddenly moves backward and then forward
MECHANISM OF HEAD INJURY
Rotational injury: Occurs when forces cause the brain to twist
within the skull and can cause injury to the nerve fibers in the brain
Rotational acceleration-deceleration injury: Brain is twisted inside
the skull which results in torsion and shearing of axons and possible
vascular disruption
Deformation injury: Results from the direct or indirect transmission
of energy to the skull. If the force is sufficient, the part is deformed
and fracture (skull fracture)
MECHANISM OF HEAD INJURY
Coup-countercoup injury:
• After the head strikes the wall, a coup injury
occurs as the brain strikes the skull
(primary impact).
•The countercoup injury (secondary impact) occurs
when the brain strike the skull surface opposite the
site of the original impact
CLASSIFICATION
According to GCS head injury is classified into:
1. MILD : GCS 13-15 with LOC to 15 minutes.
2. MODERATE : GCS 9-10 with LOC for up to 6
hours.
3. SEVERE : GCS 3-8 with LOC greater than 6
hours.
TYPES OF HEAD INJURY
1.Scalp
2. Skull fracture 3. Open 4. Closed 5. Brain injury
lacerations
a. Diffused
a. Linear
Axonal injury
d. Comminuted
e. Compound
TYPES
1. Scalp lacerations:
• Are easily recognized
• Are associated with
profuse bleeding
TYPES
2. Skull fracture:
a. Linear
• Break in continuity
of bone
• Cause by low velocity
injuries
TYPES
b. Depressed:
• Inward indentation of skull
• Cause by powerful blow
TYPES
c. Simple:
• Without fragmentation
or communicating laceration
• Cause by low
to moderate impact
TYPES
d. Comminuted:
• Multiple fracture with
fragmentation of
bone into many pieces
• Direct, high - momentum
impact
TYPES
e. Compound:
• Depressed skull fracture and
scalp with laceration with
communicating pathway to
intracranial cavity
• Severe head injury
TYPES
3. Open:
• Cranium is fracture and/or
the membrane that surround
the brain (dura mater)
are breached
TYPES
4. Closed:
• Does not cause damage
to the dura mater and skull
TYPES
5. Brain injury:
a. Diffuse axonal injury (DAI)
• Widespread axonal damage
or shearing of axons
resulting in axonal
disconnection
TYPES
b. Diffuse injury:
• Concussion: A sudden transient mechanical head injury
with disruption of neural activity and change in
the LOC, considered as minor injury
• Signs include a brief disruption in LOC,
retrograde amnesia and headache
• Postconcussion syndrome include persistent
headache, lethargy, personality and behavioural
changes, shortened attention span and short-
term memory loss
TYPES
c. Focal injury:
• Contusion: A bruising of the brain tissue within
a focal area associated with head injury
• May contain areas of haemorrhage, infarction,
necrosis and edema and it frequently occur at a
fracture site
• Seizures are a common complication of brain
contusion especially in the first 7 days after injury
• With contusion a phenomenon of coup-counter-
coup phenomenon is noted
RISK FACTORS
oColour blindness
oAlcohol addiction
oVertigo
oChildren up to 4 years old
oYoung adult between 15 to 24 years
oAdult age 60 and above
oMilitary personnel
oMales
ETIOLOGY
Blunt Penetrating
Motor vehicle collision Gunshot
Pedestrian events Arrow
Falls
Assault
Sport injuries
Explosive blasts
PATHOPHYSIOLOGY OF TBI
Due to etiological factors