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Definition
Head injury is an injury to the scalp, skull, or brain.
The most important consequence of head injery is traumatic brain injury.
Head injury may occur either as a closed head injury, such as the head hitting a car or as a penetrating head injury, as when a bullet pierces the skull. Both may cause damage that ranges from mild to severe .
Very severe injury can be fatal because of profound brain damage.
Possible injuries to Brain Cerebral Contusion Is the commonest form of
traumatic intra-axial injury. Contusions occur at the inferior and polar surfaces of the frontal
and temporal lobes. Cerebral contusions are also
produced secondary to depressed skull fractures and are associated with other intracranial injuries
Clinical features
Brain injury may be generalized with widespread brain damage ( In this case an increase in the vascular permeability will occur resulting in cerebral edema
decreased respiratory exchange in severely
injured patients also leads to anoxia resulting in cerebral vasodilatation which lead to cerebral swelling
Usually associated with a brief loss of consciousness.
The elderly patients, alcoholics and patients
taking anticoagulants are at increased risk of hemorrhage
Radiological features Non-contrast computed
tomography (CT) useful in the early posttraumatic period.
Contusions are seen as multiple focal areas of low or mixed attenuation intermixed with tiny areas of increased density representing hemorrhage.
True extent becomes apparent over time with progression of cell necrosis and edema.
Magnetic resonance imaging (MRI) is the best modality for demonstration of edema and contusion distribution.
Cerebral contusions in both frontal lobes (arrows). The adjacent low density represents local edema.
Skull fractures Skull fractures are more serious than other
bones fractures if the brain is injured These fractures can be classified into :- Closed if the overlying skin is intact OR Compound if the overlying skin is affected Linear if there is a single fracture line Stellate if there is several fracture lines
radiating from a central point Depressed or not depressed according to
the movement of the fracture edges below the level of surrounding bone
Simple Skull fractures This may be linear- stellate or comminuted but not
depressed if they cross the major vascular channels epidural and
subdural haematoma may occurs the patient with this type of fractures should be kept
under close observation until certain that no bleeding is occurring
)Simple vault fracture )arrowheads
• Depressed fractures affects the underlying brain cortex which may cause neurologic effects
• Some time called ping-pong fractures
• A tangential view may use to show the degree of depression if CT unavailable
Depressed Skull fractures
Skull Base fractures Are fractures through the dense
inner structures of the temporal bone
the major signs includes rhinorrhea , otorrhea
this type of fractures is very difficult to demonstrate according to the complex anatomy through this area.
If bleeding occurs plain radiographs may revel air-fluid level in the sphenoid sinus ( lateral view)
the use of CT scan is more effective to demonstrate this type of fractures
skull base fracture
Gunshot wounds Gunshots can be visualized by plain film images
which used to localize the bullets in gunshot victim ( the bullet is easily localized because of lead contents Scalp injuries
Scalp is an extremely vascular structure , and injury may cause serious hemorrhage
All scalp wounds should be closed as soon as possible unless they overlying a depressed fracture or penetrating wound of the skull which need special care in the operating room
The common Scalp injury is laceration
investigations
Skull films are not indicated routinely for the following indications:
Headache Possible pituitary problems - ( CT/MRI preferred) Possible space occupying lesion Epilepsy Dementia or memory loss Middle or inner ear problems Temporal mandibular joint dysfunction - will not
show disc abnormality which is the most common cause of dysfunction.