Head trauma

• What is the definition of head trauma?

  It is an injury to the head (scalp, skull & brain) due to trauma.
• What are the common causes of head trauma?

  Road Traffic Accident (RTA), fall, non-firearm assault, firearm assault, and other/unknown causes.
• What are the important pathophysiology concepts related to head trauma?

  1. Brain is contained in a rigid and inelastic skull.
  2. Cerebral perfusion pressure (CPP) is calculated as:

  $CPP =$$MAP - ICP$

  1. Coup and countercoup injuries occur at the site of impact and opposite the impact, respectively.
• What is the formula for cerebral perfusion pressure (CPP)?

  CPP = MAP - ICP
• What are coup and countercoup injuries?

  Coup injuries occur under the site of impact, while countercoup injuries occur on the side opposite the impact.
• How is head trauma classified?

  1. According to the type of injury:

  • Blunt trauma
  • Penetrating trauma (high velocity and low velocity)

  1. According to the site of injury:

  • Scalp injury
  • Skull injury
  • Brain injury
  • Intracranial vascular injury
• What are the types of scalp injuries?

  1. Subgaleal hematoma (usually reabsorbed, sometimes needs aspiration)
  2. Abrasion
  3. Laceration and avulsion (profuse bleeding, requires urgent surgical closure)
• What is a linear skull fracture?

  A linear fracture is a simple skull fracture that requires no treatment.
• What is a depressed skull fracture?

  A depressed fracture involves the skull bone being forcefully displaced downward, sometimes embedded in brain tissue, requiring surgical intervention.

  
• What are the characteristics of a base of skull fracture?

  It is characterized by CSF leak, bleeding from the nose and ear, raccoon eyes, Battle's sign, and may require surgical intervention if CSF leak persists.

  
• What are the types of primary brain injuries?

  1. Cerebral concussion: temporary interruption of neurological function.
  2. Cerebral contusion: bruises and hemorrhage in brain parenchyma without surface laceration.
  3. Cerebral laceration: severe injury with breach in surface parenchyma.
  4. Diffuse axonal injury: disruption of axons, severity ranges from confusion to coma.
• What are the types of secondary brain injuries?

  1. Cerebral edema
  2. Intracranial hematoma
  3. Brain herniation
  4. Cerebral ischemia
  5. Infection
  6. Epilepsy
• What are the types of intracranial vascular injuries?

  1. Epidural hematoma: arterial bleeding, biconvex shape on CT, treated with surgical evacuation.
  2. Subdural hematoma: venous bleeding, concavo-convex shape on CT, treated with surgical evacuation.
  3. Subarachnoid hematoma: treated conservatively, may need clipping or embolization.
  4. Intracerebral hematoma: hyperdense lesion on CT, treated based on severity.

  
• What is the management protocol for head trauma patients?

  1. Primary survey (ABCDE)
  2. Resuscitation
  3. Secondary survey
  4. Monitoring & transfer to definitive care
• What should be included in the history for a head trauma patient?

  • Mechanism of injury
  • Loss of consciousness or amnesia
  • Evidence of limb weakness or numbness, seizure
  • Problems with walking or talking
  • Vomiting, blurring of vision
  • Headache
• What neurological assessments should be performed in head trauma patients?

  • Glasgow Coma Scale (GCS)

  1. Minor head injury: GCS = 15, no LOC
  2. Mild head injury: GCS = 14-15, with LOC
  3. Moderate head injury: GCS = 9-13
  4. Severe head injury: GCS ≤ 8

  • Pupillary size & reaction
  • Muscle power, tone, reflexes

  
• What investigations are typically performed for head trauma?

  • CBC
  • U/E/C
  • ABG
  • Skull & cervical spine X-ray
  • CT scan of skull, brain & cervical spine
  • MRI of the brain
• What is the general treatment approach for head trauma?

  • Preserve brain homeostasis and prevent secondary injuries.
  • Observation and supportive treatment:

  1. Analgesia
  2. Anticonvulsants
  3. Diuretics
  4. Corticosteroids
• What should be done in case of high intracranial pressure (ICP)?

  Elevation of the head by 30 degrees, hyperventilation, and diuretics.
• What are the surgical interventions for brain injury?

  1. Evacuate hematoma (Burr-hole)
  2. Elevate depressed skull fracture
  3. Decompressive craniotomy for diffuse cerebral edema & high ICP
  4. Close scalp wounds