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Categories of Diffuse Brain Injury

5

DAIMild (coma > 6 -24 hrs)

Persistent residual cognitive, phsychologic,

sensorimotor deficit

Decorticate and decerebrate posturing

Experience prolonged period of stupor

Permanent deficit in memory, attention,

abstraction, reasoning, problem solving,executive function, vision or perception

and language.

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DecorticateDecorticate vsvs DecerebrateDecerebrate

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Moder teModer te

WidespreadWidespread i ir ent erebr l ortex, diencephalon,i pair ent cerebral cortex, diencephalon,

tearingofaxons bothhemispheretearingofaxons bothhemisphere

TransitorTransitor decorticationdecortication orordecerebrationdecerebration..

Unconsciousness lastingdaysor weeks.Unconsciousness lastingdaysor weeks.

Onawakening theperson isconfusedandsuffer longOnawakening theperson isconfusedandsuffer longperiodofpostperiodofpost--traumatictraumaticanterogradeanterograde and retrogradeand retrograde

amnesia.amnesia.

Categoriesof Diffuse Brain Injury

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SevereSevere (LO week)(LO week)

Severemechanical disruptionsofaxons inSeveremechanical disruptionsofaxons in

both hemisphere, diencephalonand brainstem.both hemisphere, diencephalonand brainstem.

Immediate autonomic dysfunction that disappearImmediate autonomic dysfunction that disappear

in few weeks.in few weeks.

IIII -- daysafter injury.daysafter injury.

compromisedcoordinatedmovements withverbalcompromisedcoordinatedmovements withverbaland writtencommunication, inability to learnand reason,and writtencommunication, inability to learnand reason,

inability tomodulatebehavior.inability tomodulatebehavior.

ategoriesof Diffuse Brain Injury

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Compound FractureCompound FractureObject strikes the head

with great force or

head strike the objectforcefully temporal or

occipital blow upward

impact of cervical

vertebrae (basilar skull

fracture)

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Penetrating InjuryPenetrating InjuryMissile (bullets) or

sharp projectile

(knives, axes,screwdriver)

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CENTRIPETA APPR ACH

(outside to inside)

Scalp

Cranium

Subdural

Subarachnoid

Intra-parenchymal Intra-ventricular

- Epidural

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Subgaleal

Subdural

Epi-arachnoidSubarachnoid

Parenchymal Hemorrhage

Intra-ventricular

Cephalohematoma

Subperiosteal uter Table

Epidural (Extradural)

Subperiosteal Inner Table

Traumatic Hemorrhage:

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EPID RA HEMAT MAEPID RA HEMAT MA

Source of BleedingSource of Bleeding

Arterial (high pressure)

Venous (lo pressure)

High flo , lo pressure

Diploic veins (Fx)

Marro sinusoids

MENINGEA VESSE S

D RA SIN S

THERS

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Epidural Hematoma:

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Trauma -> fracture & concussion

Tearing/stripping of both layers

from inner table

aceration of outer periosteallayer

aceration of meningeal vessels

Inner (meningeal dura) intact

Blood bet een naked bone anddura

NORMAL art rial pr ur

continu to di ct

EPID RA HEMAT MA

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EPID RA HEMAT MAEPID RA HEMAT MA

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EPID RA HEMAT MAEPID RA HEMAT MASignificant trauma

Fracture & concussion (l.o.c)

Delayed neurologic Sx (hrs. ater)

Herniation, coma and death

Lucid Int rval pt Wakes Up

40% pts.

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SUBDURAL HEMATOMASUBDURAL HEMATOMA

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SUBDURAL HEMATOMASUBDURAL HEMATOMA

HEMATOMA TYPESOF INJURY ONSETOFS/S CLINICALMANIFESTATION

Acute Severe Head Injury ithin hours Rapid deterioration to dro siness,

agitation, stuporous, coma, signs of

brain stem compression, pupil

dilation contralateral hemiparesis.

Subacute Moderate Head

Injury

2 hours to eeks

after

ucid , Dro siness, stuporous coma,

Increase ICP

Chronic Mild Head Injury eeks - months

after

Dull headache, slo ness in thinking,

apathy, dro siness, contralateral

hemipareresis, progressive

neurologic changes, aphasia,

papilledema, C changes.

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INTRACEREBRA HEMAT MAINTRACEREBRA HEMAT MA

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