HEAD INJURIES

Question 1

Definition of head injury

Answer 1

Any mechanical trauma that produces either gross or subtle changes in the head.

Question 2

types of head injury

Answer 2

Open : associated with wounds & or skull fracture.

Closed : Intracrainial injuries.

Question 3

Anatomical :

Answer 3

I- Scalp wounds.

II- Skull Fracture

III- Intracranial

A) Meningeal B) Brain

Question 4

I- Scalp wounds

Answer 4

Contusions or scalp hematomas Lacerations Torn flap wounds Cut wounds Cut lacerated Firearm wounds

Question 5

Scalp hematomas

Answer 5

Question 6

Black eye

Answer 6

: it occurs due to

• Direct blow.
• Gravitational à seepage of blood beneath the scalp from bruise above

the eye brow.

Question 7

II- Fractures of the skull

Answer 7

Question 8

I- Vault fractures:

Answer 8

• Fissure fracture:
• Polar fracture:
• Diastatic fracture:
• Thermal fracture :
• It is a fissure occurring in case of severe burn of the head due to:
• a. Evaporation of H2O inside the cranial cavity à ­I.C.T. or
• b. Evaporation of H2O from outer before inner tables.

Question 9

Differences between thermal and Traumatic Skull Fractures

Answer 9

Question 10

2- Fracture of the base

Answer 10

They are usually fissure fractures.

1. Causes:

• Extension from the vault.
• Blow to the face.
• Fall from height on buttock or heel à fracture around foramen magnum (ring fracture).
• Car accident (Hinge fracture i.e. separation of the base of the skull into 2 halves).

Question 11

Clinical picture of Skull Fractures:

Answer 11

Question 12

Clinical picture of Skull Fractures: cont.

Answer 12

Question 13

Comminuted fracture is due to:

Answer 13

due to a blow with a heavy blunt object having a wide striking surface

Question 14

Depressed fracture:

Answer 14

•due to a heavy blunt object having a localized striking surface.

Question 15

Cut fracture:

Answer 15

•due to heavy sharp objects

Question 16

Healing of skull fracture

Answer 16

Question 17

A- Intracranial hemorrhages: (The main meningeal injuries)

Answer 17

1- Extradural hge :

• almost always traumatic
• tear of the M.M.A. or one of the venous sinuses or a diploic vessel in the extradural space.
• P.M.P. : Asphyxia, hematoma and brain flattening shift of mid-line of the brain if large hematoma., fissure fracture, and torn M.M.A.

Question 18

2- Subdural hge types:

Answer 18

Traumatic:

• Acute: (Mainly bridging veins)
• Mechanism :
• Chronic : (Pachymeningitis hemorrhagica) :
• in alcoholics and diabetics due to repeated minor traumata;
• the clot is laminated denoting multiple bleedings occurring over different periods.
• PM P :

Pathological : extension from subarachnoid or cerebral hemorrhages.

Question 19

3- Subarachnoid hge types :

Answer 19

• Pathological (commoner than traumatic)
• Extension from path. Intracerebral hge .
• Rupture of an aneurysm :
• Mycotic
• Congenital
• Traumatic :
• Rare to occur alone( usually accompanied with extra or subdural hges.

Question 20

B- The brain injuries

•The mechanism of brain injury:

Answer 20

• By direct intrusion: Either by penetrating weapon, bullet or other missile or by bone fragments of skull.
• By deformation of the brain in closed head injuries: It is now accepted that the changes in the velocity (either acceleration or deceleration) and the rotational shear force lead to cerebral damage.

Question 21

Localized brain lesions

Intracerebral hemorrhage

Answer 21

•Traumatic

1. due to extension of haemorrhage from surface contusions deep into the substance of the brain
2. the result of rupture of small blood vessels deep within the brain due to shearing stress.

• Pathological cerebral apoplexy

1. due hypertension and atherosclerosis of cerebral arteries.
2. Hge commonly occurs in corpus striatum due to rupture of leniculo-striate artery.
3. tapers as it approaches brain surface.

Question 22

Cerebral contusion

Answer 22

Question 23

difference between concussion and compression

Answer 23

Question 24

difference between concussion and compression cont.

Answer 24

Question 25

Fate of concussion

Answer 25

Question 26

def of Diffuse Axonal injury (DAI)

Answer 26

•diffuse injury of the axons of the brain cells associated with immediate unconsciousness and coma longer than 6 hours duration following head trauma. Common in road traffic accidents (RTA).

Question 27

•Pathophysiology of Diffuse Axonal injury (DAI)

Answer 27

• Severe rotational impact and deceleration cause tearing of the nerve tissue and disrupt the brain’s regular communication and chemical processes.
• This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.

Question 28

•PMP of Diffuse Axonal injury (DAI)`

Answer 28

• There may be nothing to see on the surface of the brain or on slicing at autopsy.
• Special stains are used to demonstrate microscopic damage. Diffuse axonal injury is often associated with brain swelling. Shearing or gliding injury may also rupture small blood vessels deep within the white matter of the brain detected as numerous deep small hemorrhages.

Question 29

Cause of death in head injures

Answer 29

•Immediately or shortly after the injury : by

1. fatal concussion,
2. compression or
3. brain lacerations.

•Delayed :

1. intracranial sepsis or epilepsy.

Question 30

Comminuted, depressed and cut fractures lead to

Answer 30

•immediate coma and death usually. There is no power of speech and movement.

Question 31

Fissure fr. : there may be a lucid interval during which

Answer 31

which power of speech and movement are present.

Question 32

Injuries of Lt frontal lobe involving Broca’s area (speech center) lead to

Answer 32

•aphasia in right handed persons.