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Head Trauma

Neurosurgical Department

Yoon Seung-Hwan, M.D.

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Classification

closed or penetration

focal or diffuse

primary or secondary

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Primary injury

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Scalp injury

contusion

laceration

hematoma

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3. contusion

- coup and countercoup contusion- frontal or temporallobe : common site

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Intracranial cause

1. brain swelling

- edema:

vasogenic: BBB permiability

o

cytotoxic: Na/K pump damage

CT: hypodensity

- hyperemia:

vasomotor paral

yis, vasodil

atation,cerebral blood flow o, IICP

CT: compression of ventricle

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2.herniation

definition?

.

clinical menifestation relatedwth : expansion rapidity, ICP,

mass size

classification:

- cingulate H.- tentorial H.

tectal, central , uncal

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Early Management

emergency care- airway

- breathing for preventions of secondary injury

- circulation

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Neurologica

lexamination

severe head injury: GCS score check

a. vital sign

-C

ushing response: hypertension and bradycardia- hypertension: pressure center compression on 4th

ventricle floor

- abnormal respiration

Cheyne-Stroke resp.: diencephalon

central neurogenic hyperventilation: prox. tegmentum

ataxic resp. - pons and medulla

- abnormal temperature

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External examination

1. head

battless sign

raccon eye sign

bank sign

2. chest and abdomen

3. spine and extremitycombined with 5 10%

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Skull x-rays

Vs vessel groove , suture line

- no sclerotic border

- more radiolucent

- rare blanching

- unilateral

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Others study

MRI, Angiography, Neurophysiological study

ICP monitoring

- indication

1) GCS < 82) CT basal cistern compression or

5mm midline shirting

- 5 7 days monitoring

CBF study: Nitrous oxide or xenon, Xenon CT, SPECTPET, Laser doppler,TCD, AVDO2,

Spectroscopy

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ICP

managment1. head elevation - 30

2. ABR - anxiolytics, neuromuscular blockers

3. hyperventil

ation-P

aCO

2

20-30 mmHg

4. CSF drainage

5. hypertonic soluion reflex autoreguation

ECF

6. diuretics

7. barbiturates

loading dose : 10mg/kg 30 3

5mg/kg 1-2mg/kg

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Scalp injury

5 layers of scalp

s: skin, c: cutanuous, a: aponeurotica

l: loose areolar tissue, p: pericranium

1) laceration

2) avulsion

3) chemical injury

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Skull

fractureMeaning:

1) 2)

1) linear fracture 2) depressed fracture

3) basal skull fracture

CSF rhinorrhea or otorrhea

ecchymosis, pneumocephalus

hemotypanum, cranial nerve injury

4) diastatic fracture

- 2mm seperation

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Epidural hematoma(EDH)

vessel: dural vessel, diploic vein, venous sinus

middle meningeal artery M/C site

temporal or temporoparietal side

## lucid interval :

:

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- skull fracture

-

- middle menigeal artery goove .

- dura mater

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Acute subdural hematoma(SDH)

bridging vein, cortical

vessel, sinus injury

.

CT .

expiratory trephination

:

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Intracerebral hematoma(ICH)

- elderly men

- 80 90%

- delayed traumatic intracerebral hematoma (DTICH))

tamponade

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Complications after head trauma

pneumocephalus

CSF fistula

rhinorrhea eustachian tube otorrhea

Dx:

CSF test

sugar, eosinophil,

radioisotope & CT cisternography

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Tx

ABR,

20 head elevation

: 1) 6 8 CSF

2) 10 12

3) pneumocephalus

4) meningitis

5) sinus or compound fracture

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- empyema

- osteomyelitis

- traumatic brain abscess

- vascular complications

CCF: internal carotid artery ICA

cavernosu sinus cavernosus

sinus

aneurysm

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Postconcussional syndrome

.

, , , , , ,

,

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Posttraumatic epilepsy

by Jennet

1 : ,

1 :

penetrating injury: 42-60%

ICH or SDH: 40%

EDH: 10%

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- 24

-

-

-

16 .

:

gliosis or interneurona

lrelationship

glial neuronal relationship

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