Anatomy and Injuries to the HeadSabino Sports Medicine

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

Skull

skull

Skull inferior view

Brain

• Part of CNS

• weight= 3 lbs.

• Uses 20% of O2 supply & 15% of blood supply

brain

• O2 deprivation results in unconsciousness and death

• Pupils will dilate w/in 60 seconds

• Brain death occurs in about 4-6 minutes

Sections of Brain

• Cerebrum• 4 lobes

• Cerebellum

• Pons and Medulla oblongata• Make up brain stem

Sections of Brain

Cerebrum

•Coordinates all voluntary muscle activity

• Interprets sensory impulses

•Controls higher mental functions•Memory, reasoning, intelligence,

learning, judgment, emotions

4 lobes of cerebrum

• Temporal• Hearing, speech

• Parietal• sensation

• Occipital• vision

• Frontal• Voluntary muscle movement, emotion, eye

movement

Cerebrum

Cerebellum

• Controls movements of skeletal muscles

• Plays role in coordination of voluntary muscle movement

Cerebellum Tests

Brain stem

• Pons• Controls sleep, posture, respiration,

swallowing, bladder

• Medulla oblongata• Regulates heart rate, breathing, blood pressure,

coughing, sneezing, vomiting

Brain Stem

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.

Meninges

Dura Mater

• Outer most layer

• Separated from bony wall of skull by layer of fat

• Contain vital arteries and veins

• Forms the epidural space

Arachnoid space

• Lines the dura mater

Pia Mater

• Membrane that lies directly on the brain

• Helps contain the cerebrospinal fluid

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

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

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

Cerebrum Tests

Thought for the day

• To preserve brain function is to maintain quality of life, which depends on how a brain injury is handled.

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

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

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

Mechanisms of InjuryContrecoup 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

Mechanisms of Injury

• Repeated Sub-concussive Blows

• Many nontraumatic blows overtime

• Example: Soccer players who head the ball frequently

Types of Head Injuries in Sports

• Cerebral Concussion

• Cerebral Contusion

• Cerebral Hematoma

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.

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

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

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

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

Skull Fracture

• Complication:• Intracranial bleeding

• Bone fragments embedded in brain

• infection

Skull Fracture

Skull Fracture

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.

• Temporary impairment of brain function• Can alter consciousness

• May disturb vision

• Can alter equilibrium

Concussion

• MOI:• Direct blow to head

• Contra coup vs coup injury

• Acceleration/deceleration/rotation forces that shake the brain within the skull

Concussion

Concussion• 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.

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

Concussion

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

Second Impact Syndrome

• Damage from concussions and brain injury is cumulative

• Occurs as result in rapid swelling of brain following a 2nd head injury sustained prior to symptoms of 1st concussion being resolved

• 2nd blow can be minor

• Most likely to occur in athletes under 20 years old

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%

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

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

Intracranial hematoma

• S/S: will vary• LOC

• Headache

• Dizziness

• Nausea

• Possible paralysis

• Increased blood pressure

• Decreased pulse rate

Intracranial hematoma

• Care:• Call 911

• Monitor athlete

• Perform any life saving skills necessary until EMS arrives

Intracranial hematoma

Epidural Hematoma

• Tear in meningeal arteries that are embedded in bony grooves of skull

• Formation of hematoma very quickly due to arterial blood pressure

Epidural hematoma

•MOI:• Blow to head

• Results of skull frature

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

Epidural Hematoma

• LIFE-THREATENING

• Care:• Call 911

• Monitor athlete

• Live saving skills as necessary

Epidural Hematoma

Subdural Hematoma

• Occurs more frequently

• Involves venous bleeding

• S/S will appear more slowly—after hours or even days

Subdural hematoma

•MOI:• Acceleration/deceleration forces that tear

blood vessels that bridge the dura mater and brain

Subdural hematoma

• S/S:• LOC

• Dilation of one pupil (unequal) usually on same side as injury

• Headache

• Nausea

• Sleepiness

• Other concussion symptoms

Subdural hematoma

• Care:• Call 911

• Monitor athlete

• Life saving skills as necessary

Subdural hematoma

Comparison of the 3 hematomas

Scalp injuries

• Lacerations

• Abrasions

• Contusions

• hematomas

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

Scalp wounds