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HEAD INJURY

HEAD INJURY . Augustine A. Adeolu Senior Lecturer and Consultant Neurosurgeon, COMUI, Ibadan NMA meeting, Oyo State , May. 2013. Objectives. Understanding of basic classification of head injuries Familiar with various causes of secondary brain assault/injury

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HEAD INJURY

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  1. HEAD INJURY Augustine A. Adeolu Senior Lecturer and Consultant Neurosurgeon, COMUI, Ibadan NMA meeting, Oyo State, May. 2013

  2. Objectives • Understanding of basic classification of head injuries • Familiar with various causes of secondary brain assault/injury • Institute appropriate measures to treat common non-surgical causes of secondary brain injury • Familiar with management of simple scalp injuries and institute initial care of complex scalp injuries and skull fractures • Institute appropriate initial care of patients with head injury • Familiar with current trends in preventing head injuries

  3. Introduction • Trauma is a neglected epidemics • Trauma is an important cause of high morbidity and mortality • Increasing use of motor as a means of transport has increased the incidence in most parts of the world • Accidents from motorcycle is particularly of a major concern in Nigeria • Most of the morbidity and mortality is from neurotrauma especially head injury.

  4. Epidemiology • Highest incidence in young active males: third decade of life (Adeolu, Malomo, Shokunbi: Adeolu et al; Adeleye et al). • Pedestrian accidents is common in Paed. and elderly • Trauma is the second most common cause of death in many series from Nigeria (Adeolu et al, others) and fourth in the US after Hrtdx, Cancer, Stroke

  5. Aetiology -RTA MVA, MCA -Fall -Gun shot Injuries Sport injuries • Swimming • Horse • skiing • Domestic accident • Industrial accidents • War

  6. Mechanism of injury • Contact injuries resulting in contusions and fractures - Inertial injuries( Acceleration – deceleration

  7. Classification • Aetiology : Penetrating or Closed • Morphological • Severity • Time frame • Primary • Secondary

  8. Causes of Secondary Brain Injury/Assaults • Hypoxia • Hypotension • Posttraumatic seizures • Raised Intracranial Pressure • Cerebral Oedema • Intracranial Haematomas • Posttraumatic hydrocephalus • Pneumocephalus • Anaemia • Electrolytes derangement • Metabolic derangement • Infection

  9. Glasgow Coma Scale • Eye opening Spont . 4 To speech 3 To pain 2 None 1 • Best Vertebral Response Oriented 5 Confused 4 Inappropriate 3 Incomprehensive 2 None 1 • Best Motor Response Obeys commands 6 Localizes pain 5 Withdraws to pain 4 Weak flexion 3 Extends to Pain 2 None 1

  10. Presentation • History of accident • -Mechanism of accident • Mode of extrication • Mode of transport to hospital • Any initial mx/1st aids • Bleeding or effluxes from the craniofacial orifices • Hx of loss of consc, when related to the accident • Any lucid interval • Weakness of the limbs • Neck or back pain • Inj to other parts of the body • Headache • Vomit • Seizure • Memory impairment, speech change • Restlessness, behavioural change

  11. Physical • Vital signs • GCS • C/nerves especially CN 2 • Spine • Long tracts • Motor • Sensory • Examine other systems

  12. Investigation • FBC, E & U, RBS • Blood gasses • Skull x-ray – AP, Lat, Towne’s view: indication • C-spine x-ray • Indications • Impaired consc, alcoholic • Post midline nuchal tenderness • CXR • CT scan – indications • MRI: Limited role in acute injury unless CT is not • available

  13. Management • General Measures • Nurse 300 head up • Assume Neck is injured • Rigid neck collar until c-spine integrity is ascertained • Hourly neurovital sign monitoring • IVF as N/S; Give maintenance fluid • Give anticonvulsant as indicated • Pass Uretheral catheter • Change to ext. catheter when pt is stable • Commence feeding as soon as possible • Parenteral • NGT • Gastrostomy • ICU Care for ventilation and ICP monitoring in severe • head injury

  14. Specific Measures • Scalp laceration: Suture in one layer after debridement • Scalp loss – plastic surgery • Skull # Close Open • Depressed Elevation Debridement • Elevated ???? Debridement • Linear Conservative Debridement • Skull base conservative • Otorrh/Rhinorrh • ExtradHaem - Craniotomy + evacuation • Subdual Haema • -Acute • Subacute • Chronic • Cerebral Haematoma • Haemorrhagiccontusion • Treatment of raised Intracranial • Treat causes of secondary brain Injury

  15. Outcome • Glasgow outcome score • Death • Persistent vegetative state • Severe disability • Moderate disability • Good recovery

  16. Trauma Prevention (Adeolu AA et al, World Neurosurgery)

  17. Public Health campaign • Appropriate legislature

  18. Fig 1 (Adeolu AA, personal series)

  19. Fig 2 (Adeolu et al, World Neurosurgery; World Neurosurg. 2012 Nov 24. doi:pii: S1878-8750(12)01363-0. 10.1016/j.wneu.2012.11.063)

  20. Figure 3 (Adeolu AA, personal series)

  21. Figure 4 (Adeolu AA, personal series

  22. Figure 5 (Adeolu AA, personal series)

  23. Figure 6 (Adeolu AA, personal series)

  24. Figure 7 (Adeolu AA, personal series)

  25. Figure 8 (Adeolu AA, personal series)

  26. Figure 9 (Adeolu AA, personal series)

  27. Figure 10 (Adeolu AA, personal series)

  28. Figure 11(Adeolu AA et al, Surgical Neurology 2006 May;65(5):503-5; Adeolu AA et al African Journal of Neurological Sciences 01/2005; 24(2):73 - 80.

  29. Figure 12 (Adeolu AA et al)

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