Head injury

Head injury

Glasgow coma scale GCS

Best eye opening

Spontaneous 4
To speech 3
To pain 2
Non 1

Best motor response

Obey command 6
Localizes pain 5
Withdrawal 4
Abnormal flexion 3
Abnormal extension 2
Non 1


Best verbal response

Oriented 5

Confused 4
Inappropriate words 3
Incomprehensible sounds 2
Non 1

Mechanism of head injury

Closed

High velocity -- car accident-

Low velocity -- FFH, assault-

Penetrating

Gun shut-
Other penetrating (open) injuries-

Severity of head injury

1-minimal GCS 15
No LOC
No amnesia
2- mild
GCS 14
Or GCS 15+ LOC < 5 min or impaired memory

3- moderate GCS 9-13

Or LOC > = 5 min
Or focal neurological signs

4-severe GCS 5-8

5- critical GCS 3-4

Morphology of head injury

1-Skull fractures
Vault
Linear-
Depressed-
Basilar
With or without CSF leak-
With or without cranial nerve palsy-


2-Intracranial lesions
Focal
EDH-
SDH-
Contusions-
Intracerebral hematoma-
Diffuse
Concussion-
Diffuse axonal injury-

SAH

Direct trauma

Cranial nerves-
Blood vessels-

Glasgow outcome scale

5 good recovery
4 moderate disability (disabled but independent)
3 severe disability (conscious but disabled)
2 persistent vegetative state
1 death


Saif AlDeen Adil Kamil
Management of head injury

1- ABC

2-Neurochecks ---2 hours------15 min
3-NPO-until the patient is alertclear fluids------ semisolid food
4-isotonic IV fluids
5-mild analgesics --- acetaminophen
6-antiemetics ---- infrequently

Neurosurgical examination

General

1-Inspection

A-Evidence of basal skull fracture
-Raccoon eyes
-Battles sign
-CSF leak
-Hemotympanum or laceration of EAM


B-Check for facial fractures

2-Craniocervical auscultation

3-Physical signs of trauma to the spine

4-Evidence of seizure

Neurological

1-level of consciousnessmental status
2-cranial nerves
3-motor system
4-sensory system
5-cerebellum

Investigations

1-haematology & biochemistry

2-skull X-Rays

-fracture ( linear or depressed )
-pineal shift
-pneumocephalus
-air-fluid level
-foreign body


3-spine X-Rays
-cervical
-thoracic & lumbar

4-CT scan

-LOC on or after trauma
-progressive headache
-drug intoxication
-seizure
-unreliable or inadequate history
-children specially under 2 years
-repeated vomiting
-amnesia
-signs of basilar fracture
-multiple trauma
-severe facial injury
-skull penetration
-linear or depressed fracture on X-Ray
-child abuse
-significant subgaleal swelling
-focal neurological signs


5-MRI
-more sensitive than CT
-not appropriate for acute head injury
-no surgical lesion demonstrated on MRI was not evident on CT
-useful after the patient is stabilized
Used to evaluate brain stem injuries & small white mater changes ( punctate hemorrhage in the corpus callosum & diffuse axonal injury )

6-angiography

Saif AlDeen Adil Kamil









Lec.1+2 Neurosurgery Dr.Bassam

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