Cranio-Cerebral Trauma Re-written by: Daniel Habashi Seminar by: Dr. Jezewski (Asshole)

History 5000 years ago Edwin Smith Papyrus (1700 B.C.) Description of 48 patient neurosurgically treated in Ancient Egypt. The first time the word “brain” was used.

Neurosurgery Made By Monks Some more history and pictures. Nothing important for a test obviously.

Main Causes Of Cranio-Cerebral Trauma Car accidents 50% Falls 30% Criminal 7% Sport 7%

GCS – Glasgow Coma Scale PointsEye responseVerbal response Motor response 6--Obeys 5-OrientedLocalizes pain 4SpontaneouslyDisorientedFlexion withdrawal 3To verbal command Inappropriate words Flexion abnormal 2To painIncomprehensible sounds Extension 1No response

GCS GCS describes patients clinical status after head trauma and influences the speed of diagnostic and therapeutic procedures GCS < 8 = serious status

Neurological Examination Reflex Flexion / Extension Anisocoria (ipsilateral not contralateral) The most important are the dynamics of symptoms

What To Do With A Head Trauma Patient? 1. head and trunk lifting 30 degrees 2. Analgosedation (Dormicum + MF / Fentanyl) 3. Osmotherapy (Mannitol) > 320mOsm/L 4. Anticonvulsant protection 5. Optimal ventilation parameters ▫pO2 100mm Hg, pCO mmHg 6. Fighting against hypovolemic shock ▫MAP > 90 mmHg ▫MAP < 90mmHg give Fluids: crystaloids, coloids, vasopressors 7. Neurological Examination 8. ICP control ▫ICP < 20-25mmHg ▫CPP> mmHg

Diagnostic Procedures 1. Head CT 2. Vertebral CT 3. Polytrauma CT 4. Chest X-Ray 5. Abdominal USG

Brain Contusion Structural in brain tissue mainly on the surface after trauma (this makes no sense grammatically but that’s what’s written) Pathomechanism: ▫Acceleration / deceleration phenomenon in head trauma ▫Mechanism contr coup(?)

Brain Contusion / Traumatic intracerebral haematoma Contusion CT 6-8 hours Enlargement of contusion with clinical impairment Craniectomy and evacuation Implantation ICP SENSOR

Subdural Hematoma Venous Origin (Bridge Veins) Acute ▫(1 st 24 hours after trauma) ▫More typical for younger people Sub-acute ▫(2-14 days after trauma) Chronic ▫(few weeks even months or years after trauma)

Subdural Hematoma – continued The veins go from the surface of the brain to the dura, and when they break there’s bleeding and collection of blood creating a hematoma in this space. Venous bleeding is different from arterial ▫Slower – and that’s why we have acute, sub-acute and chronic

Epidural Hematoma Always arterial in origin In 90% of cases coexists with a skull fracture Acute is the most frequent type It’s a dynamic hematoma with fast developing symptoms (ACUTE). Arterial in origin because of the meningeal arteries

Surgical treatment due to CT confirmation Subdural and epidural haematoma  Urgent Surgery!!! Subdural or epidural hematoma evacuation

Anterior fossa fracture and nasal liquorrhea Typical fractures in non-airbag deployed car accidents Very vey dangerous because the ethmoid, glenoid(?) and frontal sinus fractures leads to CSF leakage from the nose and ear (temporal bone fracture) Can lead to bacterial infections and meningitis

Traumatic brain edema Implantation of ICP SENSOR Decompressive craniectomy Uni or Bilateral Implantation of ICP SENSOR Intensive Anti- edematous Treatment Decompressive Craniectomy Uni or Bilateral

Osmotherapy Mannitol 20% 4 x 200 – 250ml Glicerol 100% 4 x 200ml Furosemide 60mg/d Steroids????? Decadron 0.5 – 1mg/kg 1 Bolus Golden hour – then 4 x 8 mg Anticonvulsants – diazepam, phenytoin Normothermia Barbitural coma ICP monitoring