Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head...

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Head trauma Dr.Yasir Hamandi

Transcript of Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head...

Page 1: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Head traumaDr.Yasir Hamandi

Page 2: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Aim of lecture

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

Page 3: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

objectivesClassification catigoriesClinical classification Mechanism of injuryManagementcomplications

Page 4: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Clinical classification of head injury classifiead into 5 catigories1-skull fractures: may or may not involve damage

to the underlying brainA-linear frac. B-depressed frac. C-basilar frac.

Page 5: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Linear fracture

Page 6: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Depressed fracture

Page 7: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Skull base fracture

Page 8: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.
Page 9: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.
Page 10: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

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.

Page 11: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

E.D.H

Page 12: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

S.D.H

Page 13: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

I.C.H

Page 14: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

CONTUSSION

Page 15: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

3-diffuse brain injury.:occur without macroscopic structural damage

a-cerebral concussion(transient reversible neurological dysfunc. As a result of trauma )

b-diffuse axonal injuryc-ischaemic/hypoxic neuronal

damage

Page 16: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Difuse injuryOccur in about 40% of pat. With

severe brain injury.1/3 of deathsMost 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

Page 17: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

4-penetrating injury

Page 18: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Blast injury

Page 19: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

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

Page 20: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Mechanism of head injury1- contact:require that the head strike an

object or be struck regardless of whether the blow causes the head to move afterward.

Page 21: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

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.

Page 22: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

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

Page 23: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

b-remote contact effect:vault skull frac. Away from the

impact site ,to basilar skull fractures.

Page 24: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

2-inertial(acceleration):called head motion because they

result from violent head motion,regardless of whether the head moves because of a direct blow

Page 25: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

MANAGEMENT

Ensure patent airway,blood oxygenation adequate

Page 26: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Space occupying haematoma requires urgent evacuation

Scalp lacerations

anticonvalscents

Page 27: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

EDH

Page 28: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

SDH

Page 29: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

DEPRESSED #

Page 30: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

DELAYED EFFECTS OF HEAD INJURY

1.post traumatic epilepsy

Early epilepsy (within 1 week from injury)

Page 31: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

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%

Page 32: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Risk of early epilepsy is high in

Children under 5 years

Patient with post traumatic amnesia

Patients with intracranial hematoma

Patient with compound depressed #

Page 33: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Late epilepsy(after 1 week from injury)Occur in 5% of all patients

admitted to hospitalUsually in 1st yearIn some occur after 10 y from the

injuryUsually generalized but temporal

lobe epilepsy (complex partial )occur in 20 %

Page 34: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

Late epilepsy is prevalent in patient with

Early epilepsy 25%

Intracranial hematoma 35%

Compound depressed # 17%

Page 35: Head trauma Dr.Yasir Hamandi. Aim of lecture To have an overview about head trauma,classifications,types and the management of each type.

End