1. Dr Mukhilesh R M.S

2. Salient features of Head Injury
Most common cause of death
following road traffic
accidents.
Outcome of traumatic brain
injury
not only personal loss
neuro-reahabilitaion
long term nursing care
supportive care

3. Pathophysiology of brain Injury
Cerebral autoregulation
normal blood flow – 55ml/100g/min
mean arterial pressure 50-150 mmHg

4. Monroker Kelle Doctrine ????

6. Primary vs Secondary brain Injury
Primary brain Injury
At the time of impact
Brainstem and hemispheric contusions
Diffuse axonal injury
Cortical lacerations

7. Primary vs Secondary brain Injury
Secondary brain Injury
sometime after the impact
often preventable
causes
Hypoxia PO2<8kPa
Hypotension SBP<90mmhg
Raised ICP >20mmhg
Pyrexia
Cerebral Perfusion Pressure <65mmhg
Metabolic Disturbances

8. Classification Of Head Injury
Blunt vs Penetrating
Morphological
Skull Fractures
Vault –
open / closed
linear / communited
depressed / non depressed
Base of skull fracture
Intracranial Hematoma
EDH / SDH/ SAH/ ICH

9. Clinical Features
Rule out multisystem injury esp spinal injury
Rule out non accidental causes of collapse
syncope
aneurysmal SAH
hypoglycemia
electrolyte imbalance
medications and drug abuse

10. Clinical Features
A – Airway
B- Breathing
C- Circulation
D- Disability assesment
Pupils and GCS

11. Glasgow Coma Scale - GCS

12. Racoon Eyes
Battle’s
Sign
Dilated
Pupil

13. NICE guideline for computed tomography (CT)
GCS <13
Focal Neurological deficit
Suspected open, depressed or basal skull fracture
Seizure
Vomiting >1 episode
Urgent CT even if none of the above
Age>65
coagulopathy
antegrade amnesia >30 min

14. Extradural hematoma
Neurosurgical emergency
Associated with skull fracture
Tearing of meningeal artery
PTERION – middle meningeal
Can also be dural venous bleed
LUCID INTERVAL

15. Extradural hematoma
LENTIFORM
SHAPE
MASS EFFECT

16. Management
Burr Hole evacuation of hematoma

17. Subdural Hematoma
disruption of cortical
vessel or brain laceration
significant primary brain
injury
impaired conscious level
diffuse and concave
appearance in CT
Poor prognosis

18. CONVEX SHAPE

19. Clinical Features
Small hematomas with
little mass effect –
conservative
management
Surgery inappropriate
best GCS
pupillary reactivity
age
anticoagulant drugs

20. Subarachnoid hemorrhage
Aneurysms and trauma
Traumatic SAH –
conservative Rx

21. Chronic SDH
Elderly / anticoagulant
Tear in small bridging veins and samll ASDH – silent
Hematoma breaks down – mass effect
Headache / ICT increased/ focal deficits
Rx – evacuation via Burr Hole

22. Cerebral Contusions
Coup injury
Contre coup
injury

23. ICP
Cerebral perfusion pressure
= MAP- ICP
CPP to be maintained
>65mmhg
ICP >20 mmhg – poor
outcome
ICP monitoring – ventricular
or parenchymal

24. ICP
Sedation
Diuretics
Thermoregulation – pyrexia increases brain
metabolism
Barbiturates – thiopentones
Seizure control
Decompressive craniectomy

25. Skull fractures
Vault fractures
elevation of depressed segments
wound debridement
Base of skull fractures
CSf rhinorhoea or otorrhoea
anterior fossa dural repair

26. Long term sequelae
Neurorehabilitation
Pyschological support
Seizures

27. TRAUMATIC BRIN INJURY IS A PREVENTABLE CAUSE