Head injuries

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Head injuries
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I -Scalp injuries (stretched skin) II
Skull. III- Meninges . IV- Brain
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Infection is dangerous why???

• Cut and contused wounds in the scalp
• What is the problem?

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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

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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

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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.

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Types of Fissure Fracture.

• Polar fracture
• Ring fracture
• Thermal fracture

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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

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3- Depressed comminuted fracture

• heavy blunt object having a wide Surface area and
  high momentum
• car accidents,
• fall from height.

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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.

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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

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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.

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FRACTURES OF THE BASE

• These are usually fissure fractures
• Fracture Anterior fossa ?? eye
• Fracture Middle fossa ?? ear
• Fracture posterior fossa ?? neck

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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

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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

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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

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IV- BRAIN INJURIES

• A- CONCUSSION
• Definition
• C/P
• Fate of concussion
• 1- Complete uncomplicated recovery
• 2- Death
• 3- Compression

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Lucid interval

• Definition
• Mechanism
• Medico legal importance
• Treatment of concussion observation. No
  morphine

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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

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Causes of cerebral compression

• 1- Intracranial hemorrhage.
• 2- Pressure by fragments of bone

Treatment of compression
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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

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C- brain contusiond- brain lacerationBoth
contusion and laceration can occur in cases of
coup or contre-coup lesion.
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Differences between concussion and compression

• Mechanism
• Loss of consciousness
• Pulse
• BP
• Reflexes
• Vomiting
• Pupils
• Signs of lateralization
• Treatment

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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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