1. Anatomy and Injuries to the Head Sabino Sports Medicine

2. Anatomy of head 22-28 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

3. Skull

4. skull

5. Skull inferior view

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

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

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

9. Sections of Brain

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

11. 4 lobes of cerebrum Temporal Hearing, speech Parietal sensation Occipital vision Frontal Voluntary muscle movement, emotion, eye movement

12. Cerebrum

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

14. Cerebellum Tests

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

16. Brain Stem

17. 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.

18. Meninges

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

20. Arachnoid space Lines the dura mater

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

25. 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

26. 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

27. 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

28. Cerebrum Tests

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

30. 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

31. 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

32. 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

33. 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

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

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

36. 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.

37. 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

38. 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

39. 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

40. 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

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

42. Skull Fracture

44. 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

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

46. Concussion

47. 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.

48. 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

49. Concussion

50. 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

51. 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

52. 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%

53. 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

54. 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

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

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

57. Intracranial hematoma

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

59. Epidural hematoma MOI: Blow to head Results of skull frature

60. 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

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

62. Epidural Hematoma

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

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

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

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

67. Subdural hematoma

68. Comparison of the 3 hematomas

69. Scalp injuries Lacerations Abrasions Contusions hematomas

70. 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

71. Scalp wounds