Download Head injuries final

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
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
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
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.
Types of Fissure
Fracture.
 Polar fracture:
 Ring fracture
 Thermal fracture
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
3- Depressed comminuted fracture:
 heavy blunt object having a wide
Surface area and high momentum
 car accidents,
 fall from height.
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.
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
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.
FRACTURES OF THE BASE
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These are usually fissure fractures
Fracture Anterior fossa  eye
Fracture Middle fossa  ear
Fracture posterior fossa  neck
HEALING OF SKULL FRACTURES
A- Healing of fissure fracture
1.
2.
3.
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
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
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: Coup injury or Contre-coup
B- Pathological
IV- BRAIN INJURIES
A- CONCUSSION :
* Definition
* C/P
* Fate of concussion
1- Complete uncomplicated recovery
2- Death
3- Compression
Lucid interval
 Definition:
 Mechanism :
 Medico legal importance
 Treatment of concussion :
observation. No morphine
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
central vomiting High blood
pressure  slow full pulse  coma 
death
Causes of cerebral compression
1- Intracranial hemorrhage.
2- Pressure by fragments of bone
Treatment of compression
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
C- brain contusion
d- brain laceration
Both contusion and laceration can occur in
cases of coup or contre-coup lesion.
Differences between concussion and
compression
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Mechanism
Loss of consciousness
Pulse
BP
Reflexes
Vomiting
Pupils
Signs of lateralization
Treatment
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