This document discusses common issues related to head injuries. It begins by defining head injury and describing the basic anatomy of the head. It then discusses the most common causes of head injuries like motor vehicle accidents. It details the pathophysiology and types of injuries that can occur like scalp injuries, skull fractures, and various types of intracranial hemorrhages. The clinical features, diagnosis, and management of different types of head injuries are explained. Prevention through health promotion strategies like wearing safety helmets is also covered.

1. Head Injury: Common Issues
Dr Amit Agrawal, MCh

2.  To describe which are the common pathophysiological
 features ofhead injury
 To define the mechanisms of head injuries
 Characteristic clinical and imaging findings
 To define the management and outcome
Objectives

3. Basic Anatomy
 Scalp
 Skull
 Meninges
 Dura Mater
 Arachnoid
 Pia Mater
 Brain Tissue
 CSF and Blood

4. Head Injury
 Any trauma to the scalp, skull, or brain
 Head trauma includes an alteration in consciousness

5. Head Injury: Causes
 Motor vehicle accidents
 Firearm-related injuries
 Falls
 Assaults
 Sports-related injuries
 Recreational accidents

6. Epidemiology
 Mild TBI: 82%
 Moderate to severe TBI: 14%
 Fatal TBI: 5% (7000 deaths per year)

7. Pathophysiology of Brain Injury
Brain Injury
Primary Secondary
1.Delayed cell death2.Intracranial hypertension
and mass lesion
3.Ischemia systemic
hypoxia,hypercarbia and
hypotension

8. Primary Brain Injury
Primary
Focal
@SITE
Contra-
coup
Diffuse DAI

9. Type of injuries
 Scalp Injuries
 Skull Fractures
 Depressed Skull Fractures
 Basilar Skull Fractures
 Vascular Injuries
 Penetrating Head Injury
 Intracranial Hemorrhage
 Epidural Hematoma
 Subdural Hematoma
 Subarachnoid Hemorrhage
 Intracerebral Hemorrhage

10. Clinical features
 Diminishing level of consciousness
 Headache
 Vomiting
 Seizures
 Ear, nasal or oral bleed
 Focal weakness
 Pupillary changes
 Papilledema

11. Epidural haematoma
 Classic: arterial origin, blood
collects between skull and dura
 Middle Meningeal Artery
 Dural Venous Sinuses
 Brief loss of consciousness
 Headache
 Drowsiness
 Nausea
 Vomitting
 Rapid clinical deterioration
 Talk & die

12. Subdural Hematoma
 Due to tearing of bridging
veins, blood collects
between dura and cortex

13. Subarachnoid hemorrhage
 Disruption of small vessels on
the cortex, occur along the
falx, tentorium, or outer
cortical surface

14. Intraventricular Hemorrhage

15. Diffuse Axonal Injury

16. Skull fractures
 Vault
 Skull base
 Linear
 Stellate
 Depressed
 Non-depressed
 Open/closed

17. Intra Cerebral Heamatoma
 Formed within brain tissue &
caused by shearing or tensile
forces that mechanically
stretch and tear deep small
caliber arterioles
 Most common in temporal
and frontal regions
 C/F depend on site involved

18. Concussion
 Temporary & brief interruption of neurological function after
minor head injury
 Due to shearing / stretching of white matter fibers at the time
of impact or temporary neuronal dysfunction
 Headache
 Confusion
 Amnesia
 CT/MRI cannot detect

19. Spine injury

20. Neurological Assessment
 Rapid Trauma Neurological Examination
1. Level Of Consciousness
2. Pupils
3. EOM
4. Fundi
5. Extremity Movement
6. Response To Pain
7. Deep Tendon Reflexes
8. Plantar Responses
9. Brainstem Reflexes

21. Level of Consciousness
 Glasgow Coma Scale
Eye Opening Best Verbal Best Motor
Spontaneous 4 Oriented 5 Obeys Command
6
To Voice 3 Confused 4 Localizes 5
To Pain 2 Inappropriate 3 Withdraws 4
None 1 Incomprehensible 2 Flexion 3
None 1 Extension 2
None 1

22. Diagnosis
 CT is diagnostic
 MRI
 Cerebral angiography

23. Indications for CT scan
 Skull fracture
 Deteriorating GCS
 Neurologic deficit
 Amnesia, headache
 Seizure

24. Management
 History
 General Examination
 Limited Neurologic Examination
 C-spine and other X-rays as indicated
 CT scan

25. Management
 Primary Survey and Resuscitation
 A- Airway
 B- Breathing
 C- Circulation
 D- Disability assessment
 E- Exposure
 Secondary Survey and ‘AMPLE’ history
 Conservative management
 Surgical management

26. Initial Stabilization
 Cervical spine injury
 Hypotension
 Hypothermia
 Neurogenic Hypertension
 CT scan only after hemodynamic stabilization
 Medical therapy for raised ICP
 Immediate neurosurgeon opinion
 If needed surgical management

27. Criteria for admission
 No CT scanner available
 Abnormal CT scan findings
 All penetrating head injuries
 Skull fractures
 CSF leak
 Deteriorating level of consciousness
 Moderate to severe headache
 Significant alcohol / drug intoxication
 Significant associated injuries

28.  Head end elevation – 30 degree
 Intravenous fluids
 Maintain normovolemia
 Anti-epileptics
 Hypotonic/glucose containing fluids should not be used
 Serum sodium levels monitored daily
Conservative management

29. Surgical management
 Scalp wounds cleaning & debridemant
 Elevation of depressed Fractures
 Craniotomy & evacuation of Haematoma
 Cranial decompression for reduction of ICT

30. Prevention
Health Promotion
 Prevent car and motorcycle accidents
 Wear safety helmets