HEAD INJURY

Prof. Dr. Rezina Hamid

Head of the Department
Department of Neurosurgery
 FUNCTIONAL AREAS OF BRAIN

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 HEAD INJURY

Injury to scalp/skull/brain
resulting in altered
consciousness, vomiting,
amnesia etc.

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 HEAD INJURY

CAUSES:
• Road traffic accidents
• Fall
• Assault

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 PATHOPHYSIOLOGY

Primary Head Injury

• Contusion, concussion, laceration, bone fragment, diffuse

axonal injury,

Secondary Head Injury

• I.C Haematoma, Oedema, Hypoxia, Ishchemia

Tertiary Head Injury

• Electrolyte imbalance

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 Cushing’s Triad
Head injury

Raised ICP

Decreased cerebral Perfusion

Increased Oxygen Demand

Increases BP to compensate oxygen demand

Thus leading to Hypertension (Cushing reflex)

Q) Why does Bradycardia occur?

 HEAD INJURY

Head injury Classification using the Glasgow Coma Scale

(GCS) score.

Minor head injury GCS 15 with no loss of

consciousness (LOC)

Mild head injury GCS 14 or 15 with LOC

Moderate head injury GCS 9-13

Severe head injury GCS 3-8

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Glasgow Outcome Score (GOS)
Indications for CT scan in head injury
 MILD HEAD INJURY

MANAGEMENT
• Paracetamol
• Anti emetic
• Observe patient for
danger signs

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 Concussion

- It is defined as alteration of consciousness as a result of closed

head injury.
- It is mild type of head injury.
Clinical features:
- Confusion, amnesia (key features)
- Pt maybe lethargic, easily distractable, forgetful, slow to interact
or emotionally labile.
 MODERATE HEAD INJURY

MANAGEMENT
• Pain Killer
• Anti emetic
• Anti epileptic
• Keep head end 30 degree high
• Immediate CT Scan of brain with bone
window
• Observe patient for deterioration
• Surgery if needed

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 SEVERE HEAD INJURY

MANAGEMENT
• Pain Killer
• Anti emetic
• Anti epileptic
• Keep head end 30 degree high
• Immediate CT Scan of brain with
bone window
• Ventilatory support
• Mannitol
• Decompressive surgery

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 CT SCAN OF BRAIN WITH BONE WINDOW

• Bone, calcification are chalky

white- (Hyperdense)
• Brain- isodense
• Haematoma, also hyperdense
• Air translucent black
• CSF and oedema hypodense

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DEPRESSED FRACTURE
 CT SCAN OF BRAIN WITH EPI/EXTRADURAL HAEMATOMA

 Associated with lucid

interval
 Rupture of middle
meningeal artery
 Surgical emergency
 Craniotomy and
evacuation of
haematoma.

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 ACUTE SUB DURAL HAEMATOMA

 High-energy injury, or
Elderly or anticoagulated.

 Generally requires urgent

evacuation by craniotomy/
craniectomy.
 CHRONIC SUBDURAL HEMATOMA

- Common in elderly
especially those
on anticoagulants.
- Clinical deficits result from
osmotic
expansion of a degrading clot
over
days/weeks.
- Diffuse hypodense lesion on
CT
- Burr hole drainage is usually
preferred.
 CT SCAN OF INTRACEREBRAL HAEMATOMA

• Associated with
severe head injury

• Decompressive
craniotomy and
evacuation of
haematoma and
contused brain

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 CT SCAN OF CEREBRAL CONTUSION

• Salt pepper
appearance
• May need
decompressive
craniotomy

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 SKULL BASE FRACTURE

• Panda sign
• CSF
Rhinorrhoea
• CSF Otorrhoea
• Battle sign

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DECOMPRESSIVE CRANIOTOMY
DECOMPRESSIVE CRANIOTOMY
END RESULT
DIFFUSE AXONAL INJURY
 DELAYED DETERIORATION

1) Posttraumatic Seizures.
2) Communicating hydrocephalus.
3) Posttraumatic/ Postconcussive syndrome
4) Hypogonadotropic hypogonadism
5) Chronic traumatic encephalopathy
6) Alzheimer’s disease

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 Long term Management

1. Airway Management

2. Deep vein thrombosis prophylaxis

3. Nutritional management.
AUTOPSY
THANK YOU