1.

Head Trauma

Anatomy review
Scalp
Skull
Meninges : duramater, arachnoid mater, pia mater
Brain
Ventricular system
Intracranial compartments

Physiology review
Intracranial Pressure
Elevation of ICP > reduce cerebral perfusion > exacerbate ischemia
Normal ICP for px in resting state is 10 mmHg
Monro-Kellie Doctrine
The doctrine states that the total volume of the intracranial contents must remain constant
Cerebral Blood Flow
CPP ( Cerebral Perfusion Pressure) = MAP – ICP (Intra Cranial Pressure)

Classifications of head injuries

Severity of Injury
Severe brain injury = GCS score of 8 or less
Moderate injury = GCS score 9 to 12
Mild injury – GCS score 13 to 15
Morphology
Skull Fractures
Clinical signs of a basilar skull fractures include periorbital ecchymosis (raccoon eyes),
retroauricular ecchymosis (battle’s sign), CSF leakage from the nose (rhinorrhea), or ear
(otorrhea) and dysfungtion of cranial nerves VII and VIII (facial paralysis and hearing
loss)
Intracranial Lesions
Difusse Brain Injuries
CT scan normal ,or the brain may appear diffusely swollen, and the normal gray-white
matter is absent.
Severe diffuse injuries often result from hypoxic , ischemic result to the brain from
prolonged shock or apnea occurring immediately after trauma
Focal Brain Injuries

Epidural hematomas
This hematomas typically become biconvex or lenticular in shape as they push the
adherent dura away from the inner table of the skull
The classic presentation is a lucid interval between the time of injury and neurological
deterioration
Subdural hematomas
more common. Subdural hematomas often appear to conftorm to contours of the brain in
CT scan. Damage more severe than epidural hematomas
Contusions and intracerebral hematomas
Evidence-based treatment guidelines
Management of mild brain injury
Obtain CT scan for all patients with suspected brain injury who have clinically suspected
open skull fracture, any sign of basilar skul fracture, and more tha two episodes of
vomiting, also patient who older than 65 years
Management of moderate brain injury

Management of severe brain injury

Primary survey and resuscitation
Secondary survey
Diagnostic procedures
Medical therapies for brain injury
Surgical management
Prognosis
Brain death