Current managent of closed head injuries Spotlights Zeiad

Current managent of closed head injuries Spotlights Zeiad Fayed MD Lecturer of neurosurgery Ain shams university

How serious ? • Trauma is the leading cause of death in the developed world in persons aged 1 - 45 years. • In polytraumatized patients the head is the most commonly injured part.

How old. . Male Or female ? • Head injuries primarily occur in young adults. • Males are affected more than females. • The highest incidence occur in September. . Mostly in Fridays , Saturdays and Sundays

What are the causes?

Motor vehicle accidents

Falls from Height

Assaults

How to classify head injuries ? According to Mechanism Severity Morphology

According to mechanism • Closed • Penetrating

Acoording to severity

According to Morphology Head injuries Intracranial injuries Skull fractures

Intracranial injuries • Focal - extradural - subdural - cerebral contusions - traumatic subarachnoid - traumatic intracerebral • Diffuse - mild concussion - Classic concussion - Diffuse axonal injury

Skull fractures • Vault - non depressed (fissure ) - depressed • Base

Fissure fracture

Depressed fracture

Fracture base

Extradural Hemorrhage

Indications of Surgery • Any Symptomatic EDH • Any EDH > 1 cm

Acute Subdural hematoma

Chronic Subdural hematoma

Cerebral contusion

Traumatic Subarachnoid hemorrhage

Traumatic Intracerebral hematoma

Management of Head injuries

Management of Mild head injury Risk factors • • • Post traumatic amnesia > 60 min Retrograde amnesia > 30 min Loss of conciousness > 30 min Clinical signs of skull fracture Headache Vomiting Focal neurological deficit Seizure Age < 2 y Age > 60 y Coagulation disorder High energy accident

Management of severe Head injury • • History Primary survey ( ABC ) Secondary survey ( cervical clearence ) General examination Neurologic examination Therapeutic agents CAT scan

Therapeutic agents • • • Mannitol. Steroids. Lasix. Antiepileptic. IV fluids. Hyperventilation.

Thank You!