BRAIN INJURIES

SUBMITTED BY
VINEETH JOSEPH
ROLL NO. 50
III
RD
PROF
PNPSAMC
SUBMITTED TO SALYA THANTRA DEPARTMENT, PNPSAMC
Definition
Traumatic brain injury (TBI) is a
nondegenerative, noncongenital insult to
the brain from an external mechanical
force, possibly leading to permanent or
temporary impairment of cognitive,
physical, and psychosocial functions, with
an associated diminished or altered state
of consciousness.
CLASSIFICATION OF HEAD INJURIES
1. Injury to the scalp
2. Injury to the vault of the skull
3. Injury to base of skull
4. Injury to the dura mater
5. Injury to brain
6. Injury to the blood vessels
7. Escape of cerebrospinal fluid
8. Injury to the cranial nerves

Mechanism of injury
1. Distortion of brain
2. Mobility of the brain in relation to the skull
and membranes
3. Deceleration (traffic accident) and
acceleration (blow)
4. Preexisting state of brain; effect of injuries is
greater in aging brain
1. Injury to the scalp
This is an open injury whose depth may vary
involving various layers of the scalp.
2. Injury to the vault of the skull
a) Simple
Fracture is not exposed outside through a
wound

b) Compound
Fracture is exposed outside through the
wound of the scalp


3. Injury to the base of skull
May affect either the
anterior cranial fossa or
middle cranial fossa or
posterior cranial fossa.
4. Injury to the dura mater
Associated with injury
to the scalp and skull.
5. Injury to the brain
A. Cerebral concussion
B. Cerebral contusion
C. Cerebral laceration
D. Cerebral irritation

All these are produced due to displacement and
distortion of the cerebral tissues occurring at
the moment of impact.
5. A. Cerebral concussion
Temporary physiological
paralysis
No organic structural damage
Patient becomes unconscious
for short period
Complete and perfect
recovery
Condition of shock and
develops immediately after
injury
5. B. Cerebral contusion
Rupture of white fibres of the brain causing
petechial haemorrhages
Unconsciousness is more prolonged
Pathological changes like haemorrhage, brain
swelling etc.
Patient recovers with confusion, irritability,
delirium etc.
5. C. Cerebral laceration
Brain surface is torn with effusion of blood
into the CSF leading to subarachnoid
haemorrhage
Lead to anosmia and change of personality
Lacerations may occur on the opposite side of
impact (Contra-coup injury)
Symptoms more or less similar to cerebral
contusion
A. Direct injury may fracture skull. Contusion and laceration may occur.
B. No fracture, but tearing of veins occurs. Subdural hematoma may occur.
C. Contra-coup injury
5. D. Cerebral irritation
Develops 2 to 3 days after head injury and
mainly caused by cerebral oedema
Patient not unconscious but takes no interest
in the surroundings
Recovery is apparently complete. But in
majority headache, irritability, depression,
lack of concentration, defective memory &
change of personality are expected.
6. Injury to the blood vessels
A. Subcortical
B. Subdural
C. Extradural

Injury to blood vessels cause cerebral
compression leading to deterioration in the level
of consciousness and impending danger of
death.
6. A. Subcortical haemorrhage
Produced by arterial bleeding from an area of
surface laceration or from rupture of a central
artery
Bleeding becomes fatal when it ruptures into
the ventricle causing intraventricular
haemorrhage
CT Scan of intraventricular haemorrhage
Signs and symptoms
Hyperthermia
Epileptic fits
Signs and symptoms develop from 1 to 10
days after head injury
Old blood clots in the brain may mimic
symptoms of cerebral tumours
6. B. Subdural haemorrhage
Caused by the rupture of superior cerebral
vein within the subdural space
6 times commoner than extradural
haemorrhage
Injury to the front or back of the head may
lead to this condition

Signs and symptoms
Acute form
Fatal & demands immediate surgical
interference
Subacute and chronic
Symptoms are less dramatic and consist of
headache, mental apathy, slowness to
respond to questions
CT Scan of subdural haemorrhage
6. C. Extradural haemorrhage
Results from injury to the anterior or posterior
branch of the middle meningeal artery
Injury in force is generally a blow from the
lateral side which cause fracture to temporal
bone and middle meningeal artery


CT Scan of extradural haemorrhage
Glasgow Coma Scale
This scale is composed of three tests:
Eye, Verbal and Motor responses.

Severe GCS < 9

Moderate GCS 912

Minor GCS 13
Cerebral compression
Cerebral compression mainly results from
haemorrhage from intracranial vessels or oedema
from local injury to the brain.
These patients have a lowered level of
consciousness, with Glasgow Coma Scores of
three to five
One or both pupils may be dilated and fail to
constrict in response to light.
Vomiting can also occur due to compression of
the vomiting center in the medulla oblongata
Cerebral compression - Types
Supratentorial
1.Uncal
2.Central
3.Cingulate
4.Transcalvarial
Infratentorial
5.Upward
6.Tonsillar
Cerebral compression effects
I. Elevation of blood pressure
II. Slowing of the pulse
III. Irregular respiration
IV. Ataxia
V. Nystagmus
VI. Lower cranial palsies
7. Escape of cerebrospinal fluid
CSF may be drained due to open fracture of the
anterior and middle cranial fossae through the
nose, mouth and ear.
8. Injury to the cranial nerves
3
rd
cranial nerve is the most important as it is
involved even by cerebral compression besides
direct injury.

The different cranial nerves are injured in
fracture of the different parts of the base of the
skull.
Complications after head injury
Post traumatic
headache
Insomnia
Osteomyelitis
Meningitis
Encephalitis
Post traumatic
epilepsy
Hydrocephalus
Uraemia
Diabetes insipidus

Treatment
a. Patient who has never been unconscious
Reassurance
b. Laceration of overlying skin
Remove surrounding hair
Excision of lacerated skin
Closure of wound
Antibiotics
Inj TT
Analgesics
Treatment
c. Patient who recovered from an unconscious
state
X-ray
Wound management
Appropriate symptomatic treatment
Treatment
d. General
Maintain airways
Periodic glycerine enema for bowel regulation
Catheterization
Ryles tube aspiration for feeding
Care of eye
Cold sponging

. .

(

. /)

Wound caused by fracture of the skull
through which the brain matter is visible is an

(. . /)
CONCLUSION
TBI is a major cause of death and disability worldwide,
especially in children and young adults.
Causes include falls, vehicle accidents, and violence.
In accidents, damage can be reduced by use of seat
belts, child safety seats, motorcycle helmets, and
airbags
It is important to begin emergency treatment within
the "golden hour" following the injury
Physical therapy, speech therapy, recreation therapy,
and occupational therapy may be employed for
rehabilitation.
THANK YOU
:)