Anatomy and Injuries to the Head Sabino Sports Medicine

Anatomy of head bones in skull Frontal, ethmoid, sphenoid, lacrimal, parietal (2), temporal (2), zygoma, occipital, nasal (2), maxilla, mandible Bones are joined in immovable joints called sutures Mandible is only movable bone Skull Anatomy Tutorial

Skull

skull

Skull inferior view

Brain Part of CNS weight= 3 lbs. Uses 20% of O2 supply & 15% of blood supply

brain O2 deprivation results in unconsciousness and death Pupils will dilate w/in 60 seconds Brain death occurs in about 4-6 minutes

Sections of Brain Cerebrum 4 lobes Cerebellum Pons and Medulla oblongata Make up brain stem

Sections of Brain

Cerebrum Coordinates all voluntary muscle activity Interprets sensory impulses Controls higher mental functions Memory, reasoning, intelligence, learning, judgment, emotions

4 lobes of cerebrum Temporal Hearing, speech Parietal sensation Occipital vision Frontal Voluntary muscle movement, emotion, eye movement

Cerebrum

Cerebellum Controls movements of skeletal muscles Plays role in coordination of voluntary muscle movement

Cerebellum Tests

Brain stem Pons Controls sleep, posture, respiration, swallowing, bladder Medulla oblongata Regulates heart rate, breathing, blood pressure, coughing, sneezing, vomiting

Brain Stem

Meninges 3 membranes that protect the brain and spinal cord Dura Mater Arachnoid Pia Mater The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Meninges

Dura Mater Outer most layer Separated from bony wall of skull by layer of fat Contain vital arteries and veins Forms the epidural space

Arachnoid space Lines the dura mater

Pia Mater Membrane that lies directly on the brain Helps contain the cerebrospinal fluid

Cerebrospinal fluid Clear amber in color Contained in the subarachnoid space Surrounds and suspends the brain Has chemicals that assist in proper functioning of brain Maintains regular pressure around brain Protects brain from impact

Cerebrospinal fluid With severe injury fluid may drain from ears and nose It needs to drain/escape Stopping it will increase pressure in skull Could cause more damage

Scalp Covers skull Contains large # of blood vessels, muscles and hair Skin protects against infection, keeps dirt and sweat away from eyes Decreases force of impact due to additional padding Increases inelasticity created by tension of connective tissue

Cerebrum Tests

Thought for the day To preserve brain function is to maintain quality of life, which depends on how a brain injury is handled.

Prevention of head injuries Use helmets & mouth guards Follow the rules of the sport Learn proper skills and techniques and use them Use common sense

NATA Competencies concerning Head Injuries Recognize signs and symptoms of head trauma, including loss of consciousness, changes in neurological function, cranial nerve assessment, and other symptoms that indicate brain injury Explain and interpret signs and symptoms associated with intracranial pressure Define cerebral concussion and lists the signs and symptoms used to classify cerebral concussion Assess a patient for possible closed-head trauma

Mechanisms of Injury Coup a forceful blow to resting head, producing maximal injury beneath the point of impact example: being hit with a baseball or hockey puck

Mechanisms of Injury Contrecoup moving head hits an unyielding object, producing maximal brain injury opposite the site of impact as the brain bounces within the cranium Example: head hits ground when being tackled

Mechanisms of Injury Repeated Sub-concussive Blows Many nontraumatic blows overtime Example: Soccer players who head the ball frequently

Types of Head Injuries in Sports Cerebral Concussion Cerebral Contusion Cerebral Hematoma

Cerebral Concussion Head trauma-induced alteration in mental status that may or may not involve a loss of consciousness 1. Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an ‘‘impulsive’’ force transmitted to the head. 2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.

Cerebral Contusion A bruise of the brain resulting from an impact of the skull and an object causing bleeding from injured vessels May be associated with partial paralysis, one sided pupil dilation, and altered vital signs Progressive edema may further compromise brain tissue not injured in original trauma If basic life support, proper transport techniques, and prompt expert evaluation are delivered, no surgery is needed and prognosis is good

Injuries Common MOI is impact and/or rotation Contra coup- Damage to brain on the opposite side of the initial blow Coup- Damage to brain at initial impact site. Coup-contracoup- Damage to brain on both sides Rotation after impact: causes brain stem to stop functioning normally. Nerve receptors are overloaded which can cause unconsciousness. Allows for brain to sort out impulses

Skull Fracture Various kinds Depressed Pushes portion of skull in towards brain Linear Goes across skull causing tear of vessels on inside of skull Compound Results in a portion of skull sticking through scalp Penetrating Involves object that has gone through scalp, skull, brain

Skull Fracture MOI: Direct blow to head, blunt trauma to skull S/S: severe headache, nausea, defect in skull, bleeding in ears/nose, raccoon eyes, Battle sign, cerebrospinal fluid in ears/nose Tx: call 911, immobilize head/neck, monitor, perform life saving skills if necessary

Skull Fracture Complication: Intracranial bleeding Bone fragments embedded in brain infection

Skull Fracture

Concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.traumatic brain injury Temporary impairment of brain function Can alter consciousness May disturb vision Can alter equilibrium

Concussion MOI: Direct blow to head Contra coup vs coup injury Acceleration/deceleration/rotation forces that shake the brain within the skull

Concussion

S/S: Headache “pressure in head” neck pain nausea or vomiting Dizziness Blurred vision Balance problems Sensitivity to light Sensitivity to noise Feeling slowed down Feeling like “in a fog“ “Don’t feel right” Difficulty concentrating Difficulty remembering Fatigue or low energy Confusion Drowsiness trouble falling asleep more emotional irritability Sadness nervous or Anxious Amnesia Etc., etc., etc.

Concussion Care: Remove from activity until all symptoms clear With LOC, send to ER Seek medical attention if symptoms remain Physician clearance to return to activity

Concussion

Post concussion syndrome Persistent symptoms after initial concussion Symptoms include headache, dizziness, nausea, tinnitus, confusion, inability to concentrate, fatigue Can last up to a couple weeks or longer Cannot participate until all symptoms are clear

Second Impact Syndrome Damage from concussions and brain injury is cumulative Occurs as result in rapid swelling of brain following a 2 nd head injury sustained prior to symptoms of 1 st concussion being resolved 2 nd blow can be minor Most likely to occur in athletes under 20 years old

Second impact syndrome S/S: “stunned” Walk off field on own power Lose consciousness soon after—lead to coma Dilated pupils Loss of eye movement Respiratory failure MORTALITY rate----50%

Second impact syndrome Care: Call 911 Life threatening emergency that should be dealt with w/in 5 minutes in an ER PREVENTION is the best care

Intracranial Hematoma Severe bleeding w/in the brain Intracerebral bleeding Hematoma caused increase in pressure on brain Rapid death can occur MOI: direct blow to head or head striking an immoveable object Temporal or parietal regions are more vulnerable

Intracranial hematoma S/S: will vary LOC Headache Dizziness Nausea Possible paralysis Increased blood pressure Decreased pulse rate

Intracranial hematoma Care: Call 911 Monitor athlete Perform any life saving skills necessary until EMS arrives

Intracranial hematoma

Epidural Hematoma Tear in meningeal arteries that are embedded in bony grooves of skull Formation of hematoma very quickly due to arterial blood pressure

Epidural hematoma MOI: Blow to head Results of skull frature

Epidural hematoma S/S: LOC After regaining consciousness, may appear completely lucid w/ no symptoms of head injury Symptoms of concussion can appear and gradually worsen Later---decreased level of consciousness, neck rigidity, decreased respiration & pulse rate, convulsions

Epidural Hematoma LIFE-THREATENING Care: Call 911 Monitor athlete Live saving skills as necessary

Epidural Hematoma

Subdural Hematoma Occurs more frequently Involves venous bleeding S/S will appear more slowly—after hours or even days

Subdural hematoma MOI: Acceleration/deceleration forces that tear blood vessels that bridge the dura mater and brain

Subdural hematoma S/S: LOC Dilation of one pupil (unequal) usually on same side as injury Headache Nausea Sleepiness Other concussion symptoms

Subdural hematoma Care: Call 911 Monitor athlete Life saving skills as necessary

Subdural hematoma

Comparison of the 3 hematomas

Scalp injuries Lacerations Abrasions Contusions hematomas

Scalp Injuries Mxn: Blunt or penetrating trauma S/S: Complaints of being hit, bleeding, open wound, deformity (bump) Care: Control bleeding, clean wound, refer for sutures if more that ½” long and 1/8” deep Watch for infection

Scalp wounds