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Head injuries

Head injuries. I - Scalp injuries (stretched skin) II – Skull. III- Meninges . IV- Brain. Infection is dangerous why???. Cut and contused wounds in the scalp What is the problem?. II -SKULL INJURIES. Factors governing fractures of the skull: 1- Force

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Head injuries

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  1. Head injuries

  2. I -Scalp injuries (stretched skin) II – Skull. III- Meninges . IV- Brain

  3. Infection is dangerouswhy??? • Cut and contused wounds in the scalp • What is the problem?

  4. II -SKULL INJURIES • Factors governing fractures of the skull: 1- Force 2- Striking surface area( hammer – chair) 3- Position of the head (supported or not) 4- Site of the blow: The weakest points are the squamous and temporal bones

  5. Types of skull fractures: - • 1-Skull fractures due to blunt instruments. Fissure – depressed – comminuted • 2- Skull fractures due to sharp instruments chipped - cut - cut comminuted

  6. 1-Fissure fracture (linear fracture) - Blunt instrument with wide sticking SA and low momentum. • It starts at the point of impact. • It extends parallel to the line of force. • The fissure may run into sutures • Multiple blows may produce multiple fissures, but a second fissure will end when it reaches the first fissure • Fissure fractures may be alone or they may accompany other types of fractures.

  7. Types of Fissure Fracture. • Polar fracture: • Ring fracture • Thermal fracture

  8. 2-Depressed fracture • Caused by blunt instrument with small surface area and medium force • Depressed localized fractures: It takes the shape of striking surface Usually small in size May be accompanied with fissure fracture

  9. 3- Depressed comminuted fracture: • heavy blunt object having a wide Surface area and high momentum • car accidents, • fall from height.

  10. Dangers of depressed fractures: - 1- Cerebral laceration 2- Intra cranial hemorrhage. 3- Cerebral compression. 4- Intracranial infection. 5- Subjecting the patients to a decompression operation, this leaves a bony gap and permanent infirmity.

  11. 2-Skull fractures due to sharp instruments A- Sharp and light instrument e.g. knife • Cut fracture • Chipped F tangentially causing removal of the outer table. B- Sharp and heavy instruments

  12. Injuries produced by an axe 1- The blade of an axe  cut fracture. 2-If the blade passes tangential to the outer table; chipped F 3- The cut may be triangular if the striking is done with angle 4-The striking with the head of the axe localized DF. 5- The handle of the axe fissure fractures.

  13. FRACTURES OF THE BASE • These are usually fissure fractures • Fracture Anterior fossa  eye • Fracture Middle fossa ear • Fracture posterior fossa neck

  14. HEALING OF SKULL FRACTURES A- Healing of fissure fracture • The edges are glued by serous exudates in one week • Smoothening of the edges in about 2-3 weeks • Complete closure with osseous in 3-4 months B- Healing of depressed / comminuted fracture (no bone) C- Healing of cut fractures. As those of fissure fractures

  15. Sepsis Appears in the skull in the form of bone erosion affecting either the outer, inner or both tables within 4-6 weeks. Bone erosion indicates that the cause of death is possibly septic intracranial complications - meningitis, brain abscess or sinus thrombosis

  16. III- INJURIES TO MENINGES 1- Extradural hemorrhage (Traumatic) 2- Subdural hemorrhage * Traumatic → A- acute B-Chronic(pachymeningitis haemorrhagica ) * Pathological (hypertension- Blood Disease ---) 3- Subarachnoid hemorrhage: 4- Intracerebral hemorrhage: A- Traumatic: Coupinjury or Contre-coup B- Pathological

  17. IV- BRAIN INJURIES A- CONCUSSION : * Definition * C/P * Fate of concussion 1- Complete uncomplicated recovery 2- Death 3- Compression

  18. Lucid interval • Definition: • Mechanism : • Medico legal importance • Treatment of concussion : observation. No morphine

  19. B- COMPRESSION • Definition • Mechanism Stage of irritationStage of paralysis • Clinical picture : Victim is conscious  gradually  drowsiness  blurring of vision  severe headache (mainly occipital). Then- Fever effortless centralvomiting High blood pressure slow full pulse coma  death

  20. Causes of cerebral compression 1- Intracranial hemorrhage. 2- Pressure by fragments of bone Treatment of compression

  21. The following are lateralizing signs of compression, which are diagnostic to the compressed side: On the side of hemorrhage • The pupils are unequal constricted(more on affected side) • Conjugate deviation of both eyes On the opposite side • Exaggerated reflex of the other side • Hemiplegia occurs on the contra lateral side

  22. C- brain contusiond- brain lacerationBoth contusion and laceration can occur in cases of coup or contre-coup lesion.

  23. Differences between concussion and compression • Mechanism • Loss of consciousness • Pulse • BP • Reflexes • Vomiting • Pupils • Signs of lateralization • Treatment

  24. SEQULLAE & COMPLICATIONS OF HI 1- Post traumatic amnesia or retrograde amnesia 2- Post traumatic automation 3- Post traumatic neurosis 4- Korsakoff's psychosis 5- Personality changes: 6- Jacksonian epilepsy 7-Septic complications 8-Permanent infirmity

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