Head Injuries

Head Anatomy

Head Anatomy

Scalp S: Skin C: Connective Tissue A: The aponeurosis L: Loose areolar connective tissue P: The pericranium

Brain Anatomy

Cranial Nerves I. Olfactory - Smell II. Optic - Vision III. Oculomotor – Eye movement, opening of eyelid, constriction of pupil, focusing IV. Trochlear – Inferior and lateral eye movement V. Trigeminal – Sensation to face, mastication VI. Abducens – Lateral movement of eye VII. Facial – Facial expression, taste, control of tear, nasal, sublingual salivary, and submaxillary glands VIII. Vestibulocochlear (Auditory) – Hearing and equilibrium IX. Glossopharyngeal – Swallowing, salivation, gag reflex, tongue and ear sensation X. Vagus – Swallowing, speech, regulation of pulmonary, GI, and cardiovascular functions XI. Spinal Accessory – Swallowing, trapezius, SCM XII. Hypoglossal – Tongue movement, speech, swallowing

Head Injuries Skull Fx MOI: Blunt trauma Sx: Severe headache, nausea, skull indentation, may be blood in the middle ear, blood in the ear canal, blood through the nose, ecchymosis around the eyes (“raccoon eyes”), ecchymosis behind the ear (“Battle’s Sign”), Cerebrospinal fluid may appear in the ear canal and nose Complications arise from intracranial bleeding, bone fragments in the brain, and infection

Head Injuries Concussion Immediate and transient posttraumatic impairment of neural functions (ex: alterations of consciousness, vision disturbances, loss of equilibrium, etc.) due to brain stem involvement Coup: injury occurs under the site of impact with an object Contrecoup: injury occurs on the side opposite the area that was impacted

Head Injuries Concussion Sx: Confusion Amnesia (Anterograde, Retrograde) Headache Dizziness Ringing in the ears Nausea or vomiting Slurred speech Fatigue Memory or concentration problems Sensitivity to light and noise Sleep disturbances Irritability Depression Listlessness, tiring easily Irritability, crankiness Change in eating or sleeping patterns Loss of balance, unsteady walking

Head Injuries Concussion Assessments Neurological Exam: Cognitive function Cranial Nerve testing Coordination and Motor Function Sensory Testing Reflex Testing

Head Injuries Concussion Assessments Eye Function PEARL Blurred Vision Smooth tracking Nystagmus – constant involuntary back and forth, up and down, or rotary movement of the eye

Head Injuries Concussion Assessments Balance Tests Romberg Test Balance Error Scoring System (BESS)

Head Injuries Concussion Assessments Coordination Tests Finger-to-nose Heel-to-toe walking Indicate injury to the cerebellum Cognitive Tests Serial 7’s (count down from 100 by 7) Spelling a word backwards Listing the months of the year in reverse order Test recent memory

Head Injuries Concussion Assessments Standardized Assessment of Concussion (SAC)

Head Injuries Concussion Assessments ImPACT Immediate Post-Concussion Assessment and Cognitive Testing Measures player symptoms Computer administered Can be administered on a lap-top for easy access and administration Assists physicians and athletic trainers in making difficult return-to-play decisions Permits individual and group administration Provides reliable baseline test information Results can be E-mailed or Faxed for fast consultation by a Neuropsychologist Produces comprehensive report of test results Automatically stores data from repeat testing Measures attention, memory, processing speed and reaction time Reaction time measured to 1/100th of second

Head Injuries Home Care for Concussion It is OK to: Use Acetaminophen (Tylenol) Use Ice packs Eat a light diet Sleep Rest

Head Injuries Second Impact Syndrome Occurs because of rapid swelling and herniation of the brain after a second head injury that occurs before the previous injury has healed Sx: Stunned look, within 15-20 minutes the athlete’s conditions worsens with dilated pupils, loss of eye movement, loss if consciousness leading to coma, and respiratory failure Mortality rate is approximately 50%

Head Injuries Cerebral Contusion Small hemorrhages of intracranial bleeding within either the cortex, brain stem, or cerebellum usually resulting from an impact force where the head strikes a stationary object Sx: LOC but then becomes very alert and talkative. Normal neurological exam, headache, dizziness, nausea Hospitalization and CT Scan or MRI

Head Injuries Malignant Brain Edema Syndrome Young athletes In adults, this syndrome occurs due to intracranial clots Diffuse brain swelling resulting from hyperemia (blood congests in a particular area of the body) or vascular engorgement with little or no injury to the brain Life-threatening consequences occur due to raised intracranial pressure with herniation Sx: Alert state to coma and occasionally death in minutes-hours

Head Injuries Epidural Hematoma Blow to the head that can cause a tear of the meningeal arteries Occurs extremely quickly Sx: LOC (most cases), severe head pain, dizziness, nausea, dilation of one pupil, sleepiness Later stages: deteriorating consciousness, neck stiffness, slower pulse and respiration, convulsions Life-threatening Surgically relieved

Head Injuries Subdural Hematoma Occurs more frequently than epidural hematomas and are the most common cause of death in athletes MOI: Acceleration/deceleration forces that tear vessels that bridge the dura mater and the brain 3 Kinds: Acute: Arterial bleeding Associated with other brain and skull injuries Chronic: Venous bleeding Sx: Not likely to be unconscious, dilation of one pupil, headache, dizziness, nausea, sleepiness

Head Injuries Migraine Headaches Last anywhere from 4 hours to as long as 72 hours More common in women Falling estrogen levels just before menstruation can cause a mnigraine Sx: throbbing/pulsating, may be located on one side of the head, person only wants to lie down in a dark room and sleep, nausea, vomiting, sensitivity to light, smell, or sound, visual changes (bright flashing lights, colored zigzag lines, blind spots, loss of vision on one side), tingling or numbness in arms or legs Precipitating factors: Premenstrual, menstrual, oral contraceptive pills, pregnancy, puberty, menopause, hyperthyroidism, fever, anemia, rhinitis, changes in temperature or altitude, change in activity, alcohol especially red wine, chocolates, cheese, nuts, hot dogs, drugs (nitroglycerin, nitrates, indomethacin), blood pressure changes, sleep (too much, too little)

Head Injuries Scalp Injuries MOI: usually blunt or penetrating trauma Sx: extensive bleeding

Head Injuries Stroke Lack of oxygen to the brain Often caused by interrupted blood flow from a clot or aneurism causing the blood vessels to burst Can cause a coma, paralysis, speech problems, dementia Sx: numbness or weakness is face, arm, or leg (especially on one side of the body), confusion, trouble speaking or understanding, vision differences in one or both eyes, slurred speech, trouble walking, dizziness, loss of balance and coordination, sever headache

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