Craniocerebral injury

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Craniocerebral injury
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Craniocerebral injury
1 Scalp hematomas 2 Scalp laceration 3 Scalp
avulsion
Scalp injury
1 linear fracture 2 Depressed fracture
Skull fracture
Craniocerebral injury
1 cerebral concussion 2 Diffuse axonal injury
(DIA) 3 Contusion and laceration of the brain 4
Intracranial hematomas
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Skull fracture
classification
Calvarium fracture Basilar fracture Line
fracture Depressed fracture
position configuration
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Linear fracture Clinical sign

(1)nose bleeding (2) CSF leakage through the ear
or nose (3) Bruising around the eyes or Bruising
behind the ears (4) cerebral
nerve injury VII nerve - weakness of the
face VIII nerve - loss of hearing
Olfactory nerve - loss of smell Optic nerve
- vision loss VI nerve - double vision
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Battle sign
Bruising around the eyes
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JIANG HM M34
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JIANG HM M34
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WANG DM M26
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WANG DM M26
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WANG DM M26
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Linear fracture Treatment
Most basal skull fractures do not require
treatment. CSF leakage high position of head,
inflammation prevention ,over one month need
operation Optic nerve injury fracture slice or
hematoma caused oppression need operation(lt12h)
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CHENG JF M34
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Criteria for operative repair
(1)Greater than 8-10 mm depression (or greater
than the thickness of the skull) (2)Neurologic
deficit related to pressure or injury of the
underlying brain (3)Cerebrospinal fluid leakage
(4)Open depressed skull fracture (a fracture
that communicates with the air secondary to a
laceration of the scalp)
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CHENG JF M34
Post operation
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Mechanism of Craniocerebral injury
Injury of acceleration Injury of decelation
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Cerebral Concussion
clinical sign (1) unconsciousness for up
to several minutes (2) memory loss for
recent events (3)headache , nausea ,
vomiting (4)nerve system examination , CSF
and CT scan is normal
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Diffuse Axonal Injury
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Axonal Retraction Ball
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Cerebral Contusion-laceration
Brain contusion, soft meninges, blood vessel
and brain laceration subarachnoid hemorrhage
clinical sign (1) consciousness changes (2)
orientation sign (3) high intracranial pressure
(4) brain hernia
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Cerebral Contusion-laceration
(HE coloration )
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Primary Brain-stem Injury
Conception symptoms and signs occur at the
moment of impact , no encephalic hypertension
always with diffuse axonal injury
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Thalamencephalon injury
always with diffuse axonal injury occurs at the
early time after impact
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Intracranial Hematoma
classification
position
epidural hematomas subdural hematomas intracerebr
al hematomas.
Time
acute lt72hrs subacute 3days-3weeks chronicgt3w
eeks
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Epidural Hematoma
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Epidural hematomas clinical symptom
1 trauma history 2 consciousness changes 3
pupillary response 4 Cushing syndrome
lucid interval
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ZHAO HJ M40
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chronic subdural hematomas
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DING L M 71y/o
CT
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DING L M 71y/o
MRI T2WI
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LIU SB M 64y/o
CT
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LIU SB M 64y/o
MRI T1WI
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Intracerebral hematomas
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JIANG HM M 46y/o
CT
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SONG YD M 43y/o
CT
MRI
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Observation of Brain Injury
Glasgow Coma Scale
Motor Response 6 Follows commands 5
Localizes to pain 4 Withdrawal to pain 3
Abnormal flexion 2 Abnormal extension 1 None
Eye Opening 4 Spontaneously 3 To volce 2
To pain 1 None
Verbal Respones 5 Oriented 4 Confused 3
Inappropriaate words 2 Incomprehensible
sounds 1 None
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Scalp hematomas