L3: Head Trauma Flashcards
Types (Mechanisms) of Head Injury
Pathology of Concussion
- Transient alteration of consciousness without structural damage.
- Transient disturbance in neuronal function.
Symptoms of Concussion
Headache, Nausea, Confusion, Memory loss…
Investigations for Concussion
No abnormalities in radiology.
Cortical Contusion & laceration in CT
Traumatic brain injury with CT findings.
* Hemorrhagic hyperdense
* Non hemorrhagic hypodense
Mechanism of Cortical Contusion & laceration
Coup & contre-coup (counter blow).
Site of Cortical Contusion & laceration
Usually frontal and temporal
Diffuse Axonal Injury
- Pathology
- Acceleration/deceleration to white matter.
- Shearing injury.
- Punctate hemorrhage.
Diffuse Axonal Injury
- CP
Range from mild confusion to deep coma.
Diffuse Axonal Injury
- Investigations
Near normal CT
Extradural Hematoma
- Site
Collation of blood between dura & skull.
Bleeding Source in Extradural Hematoma
- Middle meningeal artery (90% - The most common).
- Dural venous sinus.
- Bone sinusoid.
CP of Extradural Hematoma
3 phases
* Stage of concussion
* Lucid interval
* Stage of brain compression
Investigations in Extradural Hematoma
Biconvex in CT
TTT of Extradural Hematoma
- Evacuation is life-saving (Osteoplastic craniotomy flap).
- Source of bleeding should be controlled.
Def of Subdural hematoma
Collection of blood in the subdural space (between Dura matter & arachnoid).
Compare between acute & Chronic Subdural hematoma
- Time
- Causes
- Symptoms
- Investigations
- TTT
What are other Intracranial Hemorrhages?
Pathology of Brain Edema
- Accumulation of fluid beneath brain tissue
- Common finding after head trauma
Types of Brain Edema
A) Vasodilatation → Extracellular
B) Cytotoxic → Intracellular
Complications of Brain Edema
- Lead to cerebral swelling and mass effect
- Increased intracranial pressure (N < 10-15)
Cerebral perfusion Pressure
Brain Herniation
Cushing Triad
- Hypertension
- Bradycardia
- Respiratory irregularity
Mechanism of Cerebral Ischemia
Management of increased ICT
Types of Skull Fracture
Pathology of Fissure Fracture
- Usually heals spontaneously
- Dangerous if tear Dural artery e.g., MMA
DDx of Fissure Fracture
- Sutures
- Vascular marks
TTT of Fissure Fracture
- No Surgical treatment is required.
- But close observation to rarely detect EDH.
Types of Depressed Fracture
Simple & Compound
Characters of Simple Depressed Fracture
- Simple = closed (Scalp intact)
- Green stick fracture
- Ping-Pong
- High Plasticity of skull bone (Monopole skull)
Age in Simple Depressed Fracture
Usually in newborn or infant «‹ 1 Y ???
TTT of Simple Depressed Fracture
Usually non-operative management
Pathology in Compound Depressed Fracture
- Scalp wound over fracture communicate fracture to atmosphere.
- Implantation of hair and bacterial flora high risk of infection
Complications of Compound Depressed Fracture
Seizures
Brain abscess
Neurological Deficit
TTT of Compound Depressed Fracture
Elevation with good disinfection and repair of dura
Any delay in time of surgery → Increased infection rate.
Symptoms of Anterior Fossa Base Fracture
Symptoms of Middle Fossa Base Fracture
Assessment of head injury
Glascow Coma Scale Aspects
Glascow Coma Scale
- Eye Opening
Glascow Coma Scale
- Verbal response
Glascow Coma Scale
- Motor response
Grades of Head Trauma