Head injuries

II – Skull. III- Meninges . IV- Brain I -Scalp injuries (stretched skin) II – Skull. III- Meninges . IV- Brain

Infection is dangerous why??? Cut and contused wounds in the scalp What is the problem?

II -SKULL INJURIES Factors governing fractures of the skull: 1- Force 2- Striking surface area( hammer – chair) 3- Position of the head (supported or not) 4- Site of the blow: The weakest points are the squamous and temporal bones

Types of skull fractures: - 1-Skull fractures due to blunt instruments. Fissure – depressed – comminuted 2- Skull fractures due to sharp instruments chipped - cut - cut comminuted

1-Fissure fracture (linear fracture) - Blunt instrument with wide sticking SA and low momentum. It starts at the point of impact. It extends parallel to the line of force. The fissure may run into sutures Multiple blows may produce multiple fissures, but a second fissure will end when it reaches the first fissure Fissure fractures may be alone or they may accompany other types of fractures.

Types of Fissure Fracture. Polar fracture: Ring fracture Thermal fracture

2-Depressed fracture Caused by blunt instrument with small surface area and medium force Depressed localized fractures: It takes the shape of striking surface Usually small in size May be accompanied with fissure fracture

3- Depressed comminuted fracture: heavy blunt object having a wide Surface area and high momentum car accidents, fall from height.

Dangers of depressed fractures: - 1- Cerebral laceration 2- Intra cranial hemorrhage. 3- Cerebral compression. 4- Intracranial infection. 5- Subjecting the patients to a decompression operation, this leaves a bony gap and permanent infirmity.

2-Skull fractures due to sharp instruments A- Sharp and light instrument e.g. knife Cut fracture Chipped F tangentially causing removal of the outer table. B- Sharp and heavy instruments

Injuries produced by an axe 1- The blade of an axe  cut fracture. 2-If the blade passes tangential to the outer table; chipped F 3- The cut may be triangular if the striking is done with angle 4-The striking with the head of the axe localized DF. 5- The handle of the axe fissure fractures.

FRACTURES OF THE BASE These are usually fissure fractures Fracture Anterior fossa  eye Fracture Middle fossa  ear Fracture posterior fossa  neck

HEALING OF SKULL FRACTURES A- Healing of fissure fracture The edges are glued by serous exudates in one week Smoothening of the edges in about 2-3 weeks Complete closure with osseous in 3-4 months B- Healing of depressed / comminuted fracture (no bone) C- Healing of cut fractures. As those of fissure fractures

Sepsis Appears in the skull in the form of bone erosion affecting either the outer, inner or both tables within 4-6 weeks. Bone erosion indicates that the cause of death is possibly septic intracranial complications - meningitis, brain abscess or sinus thrombosis

III- INJURIES TO MENINGES 1- Extradural hemorrhage (Traumatic) 2- Subdural hemorrhage * Traumatic → A- acute B-Chronic (pachymeningitis haemorrhagica ) * Pathological (hypertension- Blood Disease ---) 3- Subarachnoid hemorrhage: 4- Intracerebral hemorrhage: A- Traumatic: Coup injury or Contre-coup B- Pathological

IV- BRAIN INJURIES A- CONCUSSION : * Definition * C/P * Fate of concussion 1- Complete uncomplicated recovery 2- Death 3- Compression

Lucid interval Definition: Mechanism : Medico legal importance Treatment of concussion : observation. No morphine

B- COMPRESSION Definition Mechanism Stage of irritation Stage of paralysis Clinical picture : Victim is conscious  gradually  drowsiness  blurring of vision  severe headache (mainly occipital). Then- Fever effortless central vomiting High blood pressure  slow full pulse  coma  death

Causes of cerebral compression 1- Intracranial hemorrhage. 2- Pressure by fragments of bone Treatment of compression

Conjugate deviation of both eyes On the opposite side The following are lateralizing signs of compression, which are diagnostic to the compressed side: On the side of hemorrhage The pupils are unequal constricted (more on affected side) Conjugate deviation of both eyes On the opposite side Exaggerated reflex of the other side Hemiplegia occurs on the contra lateral side

C- brain contusion d- brain laceration Both contusion and laceration can occur in cases of coup or contre-coup lesion.

Differences between concussion and compression Mechanism Loss of consciousness Pulse BP Reflexes Vomiting Pupils Signs of lateralization Treatment

SEQULLAE & COMPLICATIONS OF HI 1- Post traumatic amnesia or retrograde amnesia 2- Post traumatic automation 3- Post traumatic neurosis 4- Korsakoff's psychosis 5- Personality changes: 6- Jacksonian epilepsy 7-Septic complications 8-Permanent infirmity