1. Head trauma
Dr.Yasir Hamandi

2. Aim of lecture
To have an overview about head trauma,classifications,types and the management of each type

3. objectives Classification catigories Clinical classification
Mechanism of injury
Management
complications

4. Clinical classification of head injury
classifiead into 5 catigories
1-skull fractures:
may or may not involve damage to the underlying brain
A-linear frac.
B-depressed frac.
C-basilar frac.

5. Linear fracture

6. Depressed fracture

7. Skull base fracture

10. 2- focal inj.:defined as visible damage that is generally limited to a well circumscribed region;
e.g contusions(coup &countercoup),SDH,EDH,S.A.H,ICH,IVH
Occur in half of all pat. With severe brain inj.,
,and 2/3 of brain inj.related death.

11. E.D.H

12. S.D.H

13. I.C.H

14. CONTUSSION

15. 3-diffuse brain injury.:occur without macroscopic structural damage
a-cerebral concussion(transient reversible neurological dysfunc. As a result of trauma )
b-diffuse axonal injury
c-ischaemic/hypoxic neuronal damage

16. Difuse injury Occur in about 40% of pat. With severe brain injury.
1/3 of deaths
Most prevelant cause of disability in survivors of TBI.
May involve alterations in neural excitability, neurotransmission,long term receptor dysfunction
Or may be secondary to brain swelling and ischaemic injury

17. 4-penetrating injury

18. Blast injury

19. Clinical classification according to severity(G.C.S)
1-G.C.S(3-8) SEVERE
2-G.C.S(9-13)MODERATE
3-G.C.S(14-15) MILD

20. Mechanism of head injury
1- contact:
require that the head strike an object or be struck regardless of whether the blow causes the head to move afterward.

21. a- local contact effect:-
most of linear and depressed skull fracture,some basilar frac.,E.D.H,COUP Contusions.
E.D.H caused due to contact fracture that either leading to tear meningeal vessels(in adults) or bleeding from frac. Bone in children.

22. S.D.H : associated contusion and brain laceration result from contact or acceleration effect or result from torn cortical vessels especially in trivial head trauma in old age patients

23. b-remote contact effect:
vault skull frac. Away from the impact site ,to basilar skull fractures.

24. 2-inertial(acceleration):
called head motion because they result from violent head motion,regardless of whether the head moves because of a direct blow

25. MANAGEMENT
Ensure patent airway,blood oxygenation adequate

26. Space occupying haematoma requires urgent evacuation
Scalp lacerations
anticonvalscents

27. EDH

28. SDH

29. DEPRESSED #

30. DELAYED EFFECTS OF HEAD INJURY
1.post traumatic epilepsy
Early epilepsy (within 1 week from injury)

31. Occur in 5% of admitted patients with non-missile injury
Frequent in the 1st 24 hours
Focal seizures are as common as generalized
Status epilepticus in 10%

32. Risk of early epilepsy is high in
Children under 5 years
Patient with post traumatic amnesia
Patients with intracranial hematoma
Patient with compound depressed #

33. Late epilepsy (after 1 week from injury)
Occur in 5% of all patients admitted to hospital
Usually in 1st year
In some occur after 10 y from the injury
Usually generalized but temporal lobe epilepsy (complex partial )occur in 20 %

34. Late epilepsy is prevalent in patient with
Early epilepsy 25%
Intracranial hematoma 35%
Compound depressed # 17%

35. End