• Head Injury

 Injury to the head without intracranial

involvement

• Brain Injury
 Injury to the brain that cause
neurological dysregulation
• Decrease of consciousness
• No loss of consciousness, but a state of
being dazed, confused or disoriented
• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems with speech
• Difficulty sleeping
• Sleeping more than usual
• Dizziness or loss of balance
 A traumatic biomechanically induced complex
pathophysiologic process affecting the brain with no
identifiable structural abnormalities on imaging studies

 A major difference between the two is that TBI may

demonstrate abnormal structural imaging (such as
cerebral hemorrhage/contusion) and concussion, by
definition, have normal imaging studies
Post Concussion Syndrome:
•Patients having ≥ 3 symptoms including headache,
fatigue, dizziness, irritability, difficulty
concentrating, memory difficulty, insomnia, and
intolerance to stress, emotion, or alcohol, and
symptoms must begin within 4 weeks of injury and
remain for ≥ 1 month after onset of symptoms
• Glasgow Coma Scale
• Primary brain injury: occurs at time of trauma
(scalp hematomas, lacerations, bone fracture,
diffuse axonal injury, and brainstem
contusion)
• Secondary brain injury: develops subsequent
to the initial injury. Includes injuries from
intracranial hematomas, edema, hypoxemia,
ischemia vasospasm
• Cephalhematoma/Scalp Hematomas
• Skull Fracture & Skull Base Fracture
Cephalhematoma/Scalp Hematomas
Collection of blood under the scalp
 Linear

Convexity
Depressed
(cortical surface)
Skull Fractures
(Open/Closed)
Basilar
Penetrating
(Skull Base)
Skull Base Fracture
CSF otorrhea or rhinorrhea
Hemotympanum or laceration of external
auditory canal
Postauricular ecchymoses (Battle’s sign)
Periorbital ecchymoses (raccoon’s eyes) in
the absence of direct orbital trauma,
especially if bilateral
• EDH
• SDH
• ICH
• SAH
• IVH
+ Edema Cerebri
Traumatic accumulation of blood between the
inner table of the skull and the stripped-off
dural membrane
Source of bleeding
•Arterial: 85% (usually middle meningeal
artery after temporoparietal skull fracture) →
symptoms present soon after injury

•Venous: 15% (middle meningeal vein,

diploic veins, sinus) → symptoms present
hours/days after injury, more benign
“Textbook” presentation (< 10%-27% have this
classic presentation):
• brief posttraumatic loss of consciousness (LOC):
from initial impact
• followed by a “lucid interval” for several hours
• then, obtundation, contralateral hemiparesis,
ipsilateral pupillary dilatation as a result of mass
effect from hematoma
CT appearance
Hematoma is located between dura
and arachnoid layer
Acute (< 3d)
Subacute (3d-3w)
Chronic (>3w)
Source of bleeding
•Subdural accumulation of blood around/from
brain laceration (burst lobe) → more severe
primary brain injury (usually) without lucid interval
(usually)

•Rupture of bridging or cortical veins due to brain

acceleration–deceleration → less severe primary
brain injury (usually) with lucid interval
Presentation
• GCS < 8 (37–80%)
• Lucid interval (rarely present)
• Worse vs EDH
CT appearance
Hematoma is located on brain parenchyma
Presentation
• Variable (from no level of
consciousness alteration to coma)
CT Appearance
Accumulation of blood in subarachnoid
space
More common in the cerebral sulci than
in the Sylvian fissure and basal CSF
cisterns
Source of bleeding
• direct extravasation of blood from an
adjacent cerebral contusion
• arterial dissection
• direct damage to small veins or arteries
• sudden increase in intravascular
pressures leading to rupture
CT Appearance
Bleeding inside or around the ventricles, the
spaces in the brain containing the cerebral
spinal fluid
CT Appearance
Abnormal accumulation of fluid in
the intracellular or extracellular spac
es of the brain parenchyma resulting
in a volumetric enlargement of the
cells or tissue
Thank You