head injury (hi)

Head Injury (HI)

Hassan BukhariGeneral and Trauma SurgeonApr 29, 2012

Objective• By the end of this discussion, you should

be familiar with• Anatomy and physiology of the cranium• Classification of HI• Diagnosis

• Clinical• Imaging

Contents• Introduction• Classification of HI• Diagnosis• Treatment• MCQs

Introduction• Trauma is the leading cause of death in young patients

worldwide• Head injury (HI) accounts for >50%

• Goals of Intervention in HI• To reduce mortality and improve outcome• To prevent secondary brain damage• Cannot do much about primary brain damage

Anatomy of Cranium

• SCALP• Skull• Meninges• Brain• Ventricles• Tentorium

Anatomy of the cranium

Munro-Kellie Doctrine

Classification• Mechanism

• Blunt vs penetrating• Severity

• Minor• Moderate• Sever

• Morphology• Skull fracture• Intracranial lesions

Blunt vs. Penetrating injuries

Skull fracture

Intracranial lesions• Focal

• Epidural• Subdural• Subarachnoid• Intracerebral

• Diffuse• Concussion• Diffuse axonal injury• Multiple contusions

Epidural hematoma (EH)

• Convex collection• More in young• Source: MMA• Incidence: about 10%• MVC, fall and assault

Epidural hematoma• Lucid interval: observed in up to 50%.• About 40% will remain conscious throughout.• Mortality

• Overall is 10%

Subdural hematoma

• Extracranial,crescentic collection

• Source: bridging vein• MVC, fall and assault

Epidural vs. Subdural

Intracerebral hemorrhage vs. ED vs. SD

Special injury

Diagnosis

• Clinical

Diagnosis• Imaging

• Skull x-ray• CT• MRI

MCQ #1

• 34 YO M, involved in MCV, present in coma. CT brain as shown, Diagnosis is

A- SubduralB- EpiduralC- SubarachnoidD- Intracerebral bleedE- Brain contusion

✓

MCQ #2

• A 44 YO, fall from 5 meters. Present with CGS of 8. CT as shown. Diagnosis is:

A- SubduralB- EpiduralC- SubarachnoidD- Intracerebral bleedE- Brain contusion

✓

MCQ #3• 57 YO F, was hit by baseball bat to the head. She had

transient loss of consciousness. On arrival, she is full conscious and asymptomatic. During observation, she became confused and her GCS is 10. What do you call this phenomena?

A- Lucid phase intervalB- Cushion intervalC- Rebound phenomenaD- Countercoup phenomena

✓

Treatment

Treatment• Medical

• General• Specific

• Conservative• Control ICP

• Surgical• Decompressive craniotomy

MCQ #4• A 20 YO M, involved in

MCC. Came to ER with the following finding (see photo). These finding are A- Raccoon eyes B- RhinorrheaC- Basal skull fractureD- All of the aboveE- Non of the above

✓

In summary• Anatomy and physiology of the cranium• Classification of HI• Diagnosis

• Clinical• Imaging

Reference• American Association of Neurological Surgeons: Guidelines for

Surgical Management of TBI 2006. Neurosurgery 58:S2-1-S2-3, 2006.

• American College of Surgeons: ATLS® Student Course. 8th edition