1. Dr Patrick D Kamalo Neurosurgeon QECH / COM
HEAD INJURY
Dr Patrick D Kamalo
Neurosurgeon
QECH / COM

2. OUTLINE Case presentation Epidemiology of head injuries
Classification head injuries
Introduction to Mild Head Injuries
Definition and Classification of MHI
Diagnosis and evaluation
Indications for CT scan
Indications for admission
Evaluation of post-traumatic sequelae

3. OUTLINE Case presentation Classification head injuries
Prognostication in Head injury patients
Principles of Management

4. INDEX CASE
27Y, male
Motorcycle accident
GCS 15/15, ? Memory loss
Facial bruises
Observed 3 days
Returns with severe headaches
Anomia
MRI done

5. INDEX CASE

6. INDEX CASE
Lt temporal ICH
Blood over tent
Subacute SDH

7. INDEX CASE MANAGEMENT
Bur hole drainage
Anti-seizure prophylaxis
Aphasia resolved

8. Management and outcomes of SHI
INTRODUCTION
Head injury epidemiology
Classification of HI – multiple schema
Anatomical
Primary vs secondary injuries
Mechanism of injury
Morphological
CT scan based classification
Severity
Management and outcomes of SHI

9. INTRODUCTION
Primary vs Secondary Brain Injury

10. Mechanism of Injury

11. INTRODUCTION
Mechanism of Injury vs Morphology

12. CT scan based classification of diffuse brain injury
Category Initial CT findings
Diffuse injury I No visible pathology
Diffuse injury II Cisterns are present; midline shift <5 mm and/or lesion densities present, no high- or mixed density lesion >25 ml, may include bone fragments and foreign bodies
Diffuse injury III Cisterns are compressed or absent; midline (swelling) shift is 0–5 mm; no high- or mixed-density lesion >25 ml
Diffuse injury IV Midline shift >5 mm, no high- or mixed-density
(shift) lesion >25 ml
Evacuated mass Any lesion surgically evacuated
Non-evacuated High- or mixed-density lesion >25 ml, not mass surgically evacuated

13. INTRODUCTION
SHI Mortality, morbidity, survivors
Mmmmmmm
Mmm
mmm

14. Factors and
interventions
influencing
outcome
before and
after
traumatic
brain injury

15. Management of severe head injury in the ICU.
ATLS protocol – cardiopulmonary resuscitation.
Stabilise extracranial injuries
Evacuate intracranial hematomas
Keep the patients head up 30°.
Maintain normothermia.
Ventilate to a PCO2 of 30–33 mmHg.
Insert ICP monitoring device; keep the ICP at <20 mmHg.
Keep cerebral perfusion
pressure at 60–70 mmHg
Pharmacological protection
mannitol or hypertonic saline
Seizure prophylaxis for 1 week
Correct coagulopathy
Fluid and electrolyte homeostasis
Nutritional support within 72 hrs

16. Management of Intracranial Hypertension