Traumatic

Head
Injury
Annisa
20214010071
 Head Injury definition

What is traumatic head injury?????

 Any degree of injury to the head ranging from scalp lacerati

to LOC to focal neurologic deficit

Based on guidelines from the UK's National

Institute for Health and Care Excellence (NICE
Etiology

The most common cause of

01 head injuries is 28% by falls

20% of cases are caused by

02 traffic accidents

19% of cases are by struck by/

03 against

11% of cases are by assaults,

04 etc
 Classification of Head Injury
Primary Secondary
Injury sustained by
Injury sustained by
the brain after the
the brain at the time
impact
of impact
Causes: Hypoxia,
Ex : Brain
Hypoperfusion
Laceration, Brain
Ex : Cerebral
Contusion
edema,herniation
Pathophysiology
 Types of Head Injury
SCALP
LACERATION
SCALP Hematoma – The most minor type of head trauma
A Collection of blood within the skull
It’s Most commonly caused by rupture
– Scalp is highly vascular, profuse bleedin
of a blood vessel within the brain – Major complication is infection
 SKULL FRACTURE

Break in the continuity of

bone
Without alteration of
relationship of parts
Cause : low velocity injuries

Inward indentation of
skull

Cause : powerful
blow
 According to Location
Temporal bone
fracture
• Boggy temporal muscle because
extravasation of blood
• Oval shaped bruise behind the ear
in mastoid region (battle sign)
• Otorrhoea, afasia, seizzure
Parietal bone fracture Orbital fracture
• Deafness
• Periorbital
• C S F otorrhoea
e cchy mo si s
• Bulging of tympanic membrane
( R ACCO O N E Y E S )
by blood or C S F
• Optic nerve injury
• Facial paralysis
 BRAIN INJURY

• CONCUSSION
- It occurs When the brain suddenly shifts
inside the skull and knocks against
- Coup contusion: occur at site of impact in absence
the skulls bony surface
of fracture
- an unconscious state for over 3 min
- Countercoup contusion : diameterically opposite to
- Amnesia regarding event
- Headache point of impact
Glasgow Coma Scale

Injury Category GCS score

Minimal 15, no LOC or amnesia

Mild 14, or 15 with amnesia

or brief LOC or impaired
alertness or memory

Moderate 9-13, or LOC for more

then 5min or focal
neurological deficit

Severe 5-8

Critical 3-4
Complication
INTRACRANIAL HAEMORRHAGES

Extra-axial hemorrhage
• Epidural hematoma
• Subdural hematoma-Acute
Chronic
• Subarachnoid hemorrhage

Intra-axial hemorrhage
• Intra-parenchymal hemorrhage
• Intra-ventricular hemorrhage
 Initial Assesment
Primary Survey
Airway with C Spine Disability/Neurological Exposure and
Circulation with control
protection Breathing
of hemorrhage assessment: GCS environment control
 Initial Assesment

Secondary Survey

- Brief History
- Check head to Toe
- Investigation
- Reassess vital sign
- Planning
 Radiological Examination
Skull Radiography Canadian CT Head Rule
CT Imaging is only required for patients with minor head injury with any
 Can evaluate for one of the following findings. The criteria apply to patients with minor head
• Skull fractures injury who present with GCS of 13-15 after witnessed LOC, amnesia or
• Pneumocephalus confusion.
• Blood in sinus
High Risk for Neurosurgical Intervention
• Penetrating foreign body
1. GCS < 15 at two hours after injury
2. Suspected open or depressed skull fracture

CT – Scan (GoldStandard) 3. Any sign of basilar skull fracture (Hemotympanum, Peri- orbital

 Imaging modality of choice Especially good Eccymosis, Otorrhea or Rhinorrhea, Battle sign)
at identifying skull fracture, extra-axial fluid 4. Two or more episodes of vomiting
collection and hemorrhagic contusion 5. Age > 65 years

Medium risk for Brain Injury Detection by CT Imaging

6. Amnesia before impact of 30 or more minutes
Magnetic Resonance Imaging (MRI)
7. Dangerous mechanism (E.g. Pedestrican vs. Motor vehicle, Ejection

from motor vehicle or fall from an

elevation of 3 or more feet or 5 stairs)
Thank you...