No one can confidently say that he will still be living tomorrow. ~Euripides

Nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India.

of TBIs followed by falls (20%25%) and violence (10%). Alcohol involvemen t is known to be present among 15%-20% of TBIs at the time of injury.

Thirty-eight per cent of injured persons had a serious injury to the head and face region.

Head InjuryS1 Unit

DEFINITION & TYPES OF HEAD INJURY PATHOPHYSIOLOGY Clinical Features PRIMARY BRAIN INJURIES EXTRADURAL HAEMATOMA

and SUBDURAL HAEMATOMA ASSESSMENT OF SEVERITY OF HEAD INJURY INVESTIGATION CONSERVATIVE MANAGEMENT OF HEAD INJURY SURGICAL MANAGEMENT OF HEAD INJURY C O M P LI A T I N S O F H E A D C O I J RY N U

DEFINITION & TYPES OF HEAD INJURYNITHA.J

Head injuryTraumatic insult to the head that may result in

any injury to the soft tissue bony structures and/or brain.

TRAUMATIC BRAIN INJURY[TBI]Traumatic brain injury (TBI) is a

nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

CLASSIFICATION OF HEAD INJURY

Based on the SeverityGCS: Best predictor of neurological outcome

GLASGOW COMA SCALE

EYE OPENING SPONTANEOUS TO SPEECH TO PAIN NIL

SCORE 4 3 2 1

MOTOR RESPONSE OBEYS LOCALISES WITHDRAWS ABNORMAL FLEXION EXTENSION RESPONSE NIL

SCORE 6 5 4 3 2 1

VERBAL RESPONSE ORIENTED CONFUSED CONVERSATION INAPPROPRITE WORDS INCOMPREHENSIBLE SOUNDS NIL

SCORE 5 4 3 2 1

Severity Severity of TBI Minor Mild Moderate Severe

GCS 15 14-15 9-12 3-8

OPEN HEAD INJURY Implies communication b/w the intra dural contents & outside CLOSED HEAD INJURY Scalp is intact and there is no communication between the intradural contents and the atmosphere

OPEN HEAD INJURY

PATHOLOGICAL CLASSIFICATIONFOCAL Confined to specific areas Cerebral laceration Contusion Intracranial hemorrhage

DIFFUSE Distributed in a more general manner Cerebral edema Concussion Diffuse axonal injury

Based on the time of onsetPrimary BrainSecondary Brain

Injury Diffuse axonal injury Cerebral concussion Cerebral contusion Cerebral laceration Traumatic subarachnoid haemorrhage

Injury Brain swelling Intracranial Haemorrhage Infection

CLASSIFICATION OF SKULL FRACTURE

COMMINUTED FRACTURE

DEPRESSED FRACTURE

SCALP LACERATION

GCSThe scale was published in 1974 by Graham

Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow. The pair went on to author the textbook Management of Head Injuries (FA Davis 1981, ISBN 0-8036-5019-1), a celebrated work in the field.

The University of Glasgow is the fourth-

oldest university in the English-speaking world and one of Scotland's four ancient universities

PATHOPHYSIOLOGYNithin Humayoon

Neuronal InjuryChromatolysis Wallerian Degeneration Retrograde Degeneration Transneural degeneration Regeneration

Brain metabolism

CMRO2: 3.5 ml/100g/min Cerebral Blood flow

55ml/100g/min

Cerebral Autoregulation Cushings Reflex

ICP and brain herniationThe addition of mass lesion is compensated

by displacement of CSF and venous blood out of cranial cavity.

As further expansion of mass occur quite

small rise in volume result in large increase in ICP and Brain herniation can occur

MECHANISM of brain injuryDistortion of the brain Mobility of the brain in relation to the skull and

membrane Configuration of interior of skull Deceleration and acceleration of injury Cerebral Concussion Cerebral Contusion Cerebral Laceration

Primary brain injuryDiffuse neuronal damage Shearing lesions Contusion Lacerations Traumatic SAH

Extent of primary injury is reflected by state of consciousness and presence of focal neurological deficit

Secondary brain injuryBrain swelling: odema, venous congestion,

hypoxia Intra cranial hemorrhage:Extradural, subdural, intracerebral Infection Open head injury: Generalized meningitis, subdural empyema, brain abscess Closed head injury: Infection of sub pericranial blood clot

Causes of secondary brain injuryHypoxia:PO2 < 8kPa Hypotension: Systolic BP20mm Hg Low cerebral perfusion pressure: