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Head Injury

Head Injury. Prehistorycal types of trepanation. 1-вишкрібання 2-проскрібування канавки 3-пробуравлення і вирізання 4-шляхом прямокутних розрізів. Treatment of depressed skull fracture , XVI century. Classification of Brain Injury, Petit , 1774. Cerebral concussion ( commotio cerebri)

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Head Injury

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  1. Head Injury

  2. Prehistorycal types of trepanation • 1-вишкрібання • 2-проскрібування канавки • 3-пробуравлення і вирізання • 4-шляхом прямокутних розрізів

  3. Treatment of depressed skull fracture , XVI century

  4. Classification of Brain Injury, Petit, 1774 • Cerebral concussion (commotio cerebri) • Cerebral contusion(contusio cerebri) • Cerebral compression(compresio cerebri)

  5. Causes of death in different age groups other cardiovascular diseases trauma neoplasms head injury

  6. Occurrence of head injury in male and female Male Female

  7. Causes of head injury in Russia

  8. Causes of head injury in the USA • Fall from e height • Trafic accidents

  9. Males Compression Contusion Concussion Females Compression Contusion Concussion Structure of types of head injury in different age groups and sex

  10. Classification of Head Injury

  11. On pathology basis • focal • diffuse

  12. depending on infection risk • Closed • Open • penetrating • not penetrating

  13. Clinical forms of head injury • Cerebral concussion • Brain contusion • Mild • moderate • severe • Diffuse axonal injury • Cerebral compression • Head compression

  14. Initial lesions contusion diffuse axon injury hemorrhages injury of cranial nerves Secondary lesions Intracranial cerebral compression with hematomas Vioaltion of CSF and blood circulation Brain edema Extracranial Anemia hypoxemia hypertermia Pathogenesis of head injury

  15. Pathology of head injury

  16. Clinical presentations of head injury • Signs of injury on the scalp (wounds, contusion) • Impaired consciousness • Amnesia • Focal neurological deficit • Pupil asymmetry • Cranial nerve deficit • Paresis • Reflex asymmetry and depression • Aphasia • Seizures

  17. Level of consciousness • Clear consciousness - full and adequate orientation and reactions. Possible amnesia. • Mild– slight sleepiness,some time and place disorientantion, some slowness in command obey, • – hypersomnia,disorientation, only elementary verbal contact is possible, obeys only simplest verbal instructions. • Stupor – verbal contact is impossible, reactions and eye opening on pain are preserved. • Mild coma – no eye opening, noncoordinated reactions on pain. Pupil and corneal reflexes are preserved. • Severe coma – no response on pain, best motor response is extension or flexion. Pupil and corneal reflexes are decreased. Spontaneous respiration and blood circulation are preserved with probable violations. • Terminal coma – no reflexes, muscle atonia, midriasis

  18. Glasgow Coma Scale

  19. Evaluation of consciousness after Glasgow coma scale

  20. Severity of head injury • mild(13-15 point in Glasgow coma scale) – cerebral concussion, slight cerebral contusion • moderate(8-12 point) – mild cerebral contusion, subacute and chronic cerebral compression • severe(3-7 point)– severe cerebral contusion, diffuse axon injury, acute cerebral compression

  21. mild cerebral contusion – punctated hemorages

  22. mild cerebral contusion

  23. mild cerebral contusion

  24. contusion

  25. Mild cerebral contusion

  26. Mild cerebral contusion (on MRI)

  27. Two contusion focuses 1-direct blow on the right 2-countercoup on the left

  28. Depressed skull fracture

  29. Linear fractureof occipital bones with going to the skull base

  30. fracture of parietal and frontal bones

  31. Depressed fracture of parietal bone

  32. Severe cerebral contusion

  33. Severe cerebral contusion

  34. Severe cerebral contusion

  35. Severe cerebral contusion

  36. Depressed fracture of parietal and temporal bones

  37. Diffuse axon injury – there are no macroscopic lesions

  38. Axonal spheres at diffuse axon injury.

  39. Поперечний зріз аксона, норма • Після травми. відсутні мікротрубочки

  40. Typical location of diffuse axon injury (кружечки) і вогнищ геморагій (заштиховані ділянки)

  41. Diffuse axon injury on CT (no lesions)

  42. Head compression

  43. Cerebral compression • Acute – manifestation during 24 hours afterhead injury • Subacute – manifestation during 1 week afterhead injury • Chronic - manifestation after 1-2 weeks afterhead injury

  44. Causes of cerebral compression • Hematomas • Epidural • Subdural • Intracerebral • Bone fragment at depressed fructures • Pneumocephalus

  45. Main triad at cerebral compression • Deterioration of consciousness level • Ipsilateral anisocoria • contrlateral hemiparesis

  46. Epidural hematoma on the left • Subdural hematoma on the right

  47. Intracerebral hematoma

  48. Epidural hematoma on CT

  49. Epidural hematoma in posterior fossa

  50. Subdural hematoma

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