Head Trauma

Disusun oleh :
Raymond Rheza
406138024
 SCALP Anatomy
•Skin
•Connective Tissue
•Aponeurosis
•Loose connective tissue
•Pericranium (Periosteum)
 Anatomi Kesadaran
Integritas hubungan antara korteks serebri dengan sistem
formasio retikularis pada batang otak.

ARAS menyalurkan impuls dari midpons ke rostral melalui tegmentum menuju nukleus
intralaminaris thalamus untuk selanjutnya menuju korteks serebri.
 Classification
• Diffuse Axonal Injury
• Skull Fracture
• Cerebral Edema
• Cerebral Contusion
• Subdural hematoma
• Epidural hematoma
Diffuse Axonal Injury
 Diffuse Axonal Injury
• Definition: acceleration – deceleration movements of the head, especially with an
angular rotary component, cause stretching and shearing axons that manifests
clinically in loss of consciousness at the moment of impact.

• Clinical signs:
– traumatic coma lasting more than 6 hours.
– Bradhycardia or tachycardia
– Hypertension
– Hyperhidrosis
– Fever or poikilothermia
Skull Fracture
 Skull Fracture
• Linear fracture
• Depressed fracture
Cerebral Contusion
 Cerebral contusion
• Definition: focal parenchymal hemorrhages that result from “scraping” and
“bruising” of the brain as it moves accross the inner surface of the skull.
Subdural Hematoma
• Definition: blood within the potential space between
the dural and arachnoid membranes, cause is
stretching and tearing of bridging veins.
Epidural hematoma
• Definition: blood within the potential space
between the dural and skull.
• Definition: blood within the potential space
between the dural and arachnoid membranes,
cause is stretching and tearing of bridging
veins.
 Clinical Evaluation
• ABC
• Categorization of the severity of the head
injury as low, moderate, high risk
• Evaluation for fracture of the cervical spine
• Identification of any extracranial injuries
Glasgow Coma Scale(GCS)
 Risk Stratification of patients with traumatic
brain injury
Risk Category Criteria
Low • Normal neurologic exam
•No concussion
•No drug or alcohol
intoxication
•May complain of dizziness
•May have scalp abrasion,
laceration or hematoma
•Absence of moderate or
severe injury criteria
Moderate •Failure to reach GCS score of 15 within 2 hours of
injury
•Concussion
•Coagulopathy
•Anterograde amnesia > 30 min
•Vomiting
•Seizure
•Signs of possible basilar or open skull fracture
•Dangerous mechanism of injury
•Alcohol or drug intoxication

High •GCS score 3-8(comatose)

•Progressive decline in the level of consiousness
•Focal Neurologic signs
•Penetrating skull injury or palable depressed
skull fracture
 Emergency measures to reduce intracranial pressure in
unmonitored patients with clinical sign of herniation

• Head of bed elevated 15-30 degrees

• Normal saline (0,9%) at 80-100mL/h (avoid hypotonic fluids)
• Intubation and hyperventilation (target PCo2=26-30 mmHg)
• Mannitol 20% solution, 1-1,5 g/kg via rapid IV infusion
• Foley Catheter
• Neurosurgical consultation
 Treatment
• ICU settings
• Surgical intervention
• Maintain ICP and CPP
 Criteria for hospital admission following head
injury

• Intracranial blood and fracture identified on CT Scan of head

• Confusion, agitation, or depressed level of consiousness
• Focal Neurologic signs or symptoms
• Post traumatic seizure
• Alcohol or drug intoxication
• Significant comorbid medical illness
• Lack of a reliablehome environment for observation
 Case
Telah diperiksa seorang laki-laki dengan usia 17 tahun dengan keluhan
penurunan kesadaran setelah terjatuh dari sepeda motor 6 jam
SMRS.Pasien tidak sadarkan diri dari saat terjatuh sampai dibawa ke
IGD. Tidak ada pusing, mual, muntah. Tidak ada perdarahan dari hidung
dan telinga. Ada perdarahan dari mulut. Tidak ada riwayat stroke, asma,
kejang . Riwayat makan 3 kali sehari, posri cukup. Riwayat BAB dan BAK
baik.
 Pemeriksaan Neurologis

• Kesadaran : Sopor, GCS 5 (E1M2V2)

• TRM : -
• ↑ TIK : -
• Pupil : bulat, anisokor, kanan Ǿ 3mm, kiri Ǿ 2mm, RCL +/+, RCTL +/+
• N. Cranialis : Belum dapat dinilai
• Motorik : Belum dapat dinilai
• Sensorik : Belum dapat dinilai
• Fs. Serebelum dan koordinasi : Belum dapat dinilai
• Fs. Luhur : Belum dapat dinilai
• R. Fisiologis : Belum dapat dinilai
• R. Patologis : -/-
•Diagnosa :
Contusio Cerebri
 Anjuran Pemeriksaan
• Foto polos Skull
• Foto polos servical
• CT-Scan kepala
• Pemeriksaan lab :
– Darah rutin
– Elektrolit
– GDS
– AGD
 Terapi
• ABC
• Inf. NaCl 0,9% 20 tpm
• Haloperidol 2x1,5 mg
• Iansoprazole 2x1
• Mannitol extra 200cc
 Daftar Pustaka
• Current Diagnosis & Treatment Neurology. Lange
2007
• www.medscape.com