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Head Injury: Rohit Kumar PGT Dept of Surgery

This document discusses the assessment and classification of head injuries. It describes the Glasgow Coma Scale used to evaluate level of consciousness and classify injury severity. Mild injuries have GCS scores of 13-15, moderate 9-12, and severe 8 or below. Various types of primary and secondary brain injuries are outlined, including diffuse axonal injury, cerebral contusions, extradural and subdural hematomas. Imaging like CT scans are indicated for GCS below 13, focal neurological deficits, or depressed skull fractures to identify brain injuries.

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Rajarshi Kumar
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109 views29 pages

Head Injury: Rohit Kumar PGT Dept of Surgery

This document discusses the assessment and classification of head injuries. It describes the Glasgow Coma Scale used to evaluate level of consciousness and classify injury severity. Mild injuries have GCS scores of 13-15, moderate 9-12, and severe 8 or below. Various types of primary and secondary brain injuries are outlined, including diffuse axonal injury, cerebral contusions, extradural and subdural hematomas. Imaging like CT scans are indicated for GCS below 13, focal neurological deficits, or depressed skull fractures to identify brain injuries.

Uploaded by

Rajarshi Kumar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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HEAD INJURY

Rohit kumar PGT Dept of surgery

Assessment of head injury

After securing airway ,breathing and circulation,neurological evaluation is done. Assessment level of consciousness - lateralizing signs of C.N.S dysfunction -pupil size and response -full neurological examination Level of consciousness G.C.S

GLASGOW COMA SCALE


Eye opening
Spontaneous To speech To pain Nil 4 3 2 1

Best Motor Response


Obeys Localises Withdraw Abnormal response Extension response Nil 6 5 4 3 2 1

Verbal response
Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sound 2 Nil Intubated patient 1 T

G.C.S score range from 3-15

CLASSIFICATION OF HEAD INJURY SEVERITY


Classification
Mild Moderate Severe

Range of G.C.S
G.C.S 13 9G.C.S12 G.C.S8

HISTORY

Mechanism of injury Loss of consciousness Level of consciousness at scene Evidence of seizure Hypoxia or hypotension Pre-existing medical condition Medication

CLINICAL FEATURE AND INVESTIGATION


SCALP
Scalp laceration heavy bleeding -shock in infants
Scalp haematoma can masquerade depressed skull fracture

SKULL FRACTURE
Anterior fossa fracture subconjuntival haematomas anosmia epistaxis nasal tip parasthesia csf rhinorrhoea Periorbital haematoma subgaleal haemorrhage

Middle cranial fossa fracture-c.s.f otorrhoea -haemotympanum -ossicular disruption -battle sign -7th and 8th cranial nerve palsy -screened for beta transferrin
PLAIN SKULL X RAY C.T SCAN

Battle sign

Orbital blow out fracture

Orbital fat herniate and tethered within wall Painful restricted eye movement with diplopia

BRAIN INJURY
PRIMARY BRAIN INJURY
Diffuse axonal head injury

Severity can range from mild damage to coma and death M.R.I- haemorrhage in corpus callosum and dorsolatral mid brain

Mechanism of d.a.i

Cerebral concussion

Temporary cerebral dysfunction immediately after injury Bradycardia,hypotension ,sweating Amnesia of the event is common Temporary lethargy, irritability Post concussion syndrome

Cerebral contusion

Cerebral contusion and laceration

Focal neurological deficit >24 hr C.T scan -small area of haemorrhage in cerebral parenchyma

SECONDARY BRAIN INJURY


Intracranial haematomas
Intracerebral haematomas Features of midline shift and mass effect C.T scan Hyperdense lesion -Swirl sign in coagulopathic pt

Cerebral herniation

Extradural haematoma

Young age H/O transient loss of consciousness Drowsy Pupillary dilatation in later stage Features of raised I.C.T Wound and haematoma in temporal region

C.T scan-biconvex lesion X-ray

Extradural haematoma

Subdural haematoma
Acute subdural haematoma Body weakness Decreased level of alertness Slurred speech Headache Neck stiffness Seizure C.T scan-bright cresent shaped clot

Subdural haematoma

Chronic subdural haematoma

Progressive neurological deficit >3wk Initial h/o minor head injury C.T scan hypodense cresentic haematoma

Bilatral subdural haemotoma

Secondary side-effects of trauma

Infection Hydrocephalus Seizures Ischaemia

INVESTIGATION

Full blood count Electrolyte Sugar , urea Coagulation screening ABG Blood group ICP monitoring

Indication of head x ray

Oriented

-Amnesia -penetrating injury -c.s.f or blood loss -scalp laceration or swelling -persisting headache or vomiting -fall from significant height

Impaired consciousness

Indication of C.T

G.C.S <13 Deteriorating consciousness Focal neurological deficit Depressed compound fracture of vault Fracture of base of skull Penetrating injury Age >65 Coagulopathy C.T. scan should be performed with in 2-4 hr of admission

Thank you

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