,Craniocerebral Injury,Purpose : To understand the clinical features and medical treatment of head trauma Objectives: Scalp injury Skull injury Brain injury Time: 2 hours,Focus on -Classification of craniocerebral injury -Scalp hematoma clinical characteristics and Management -Depressed skull fracture (Indications for surgery) -Basal skull fractures(Presentation, Diagnosis and Management) -Cerebral concussion,Cerebral contussion and laceration injury,Brain stem injury,Diffuse axonal injury (Presentation) -Intracranial hematomas (Classification, Source of bleeding ,Clinical presentation -Glasgow Coma Scale(GCS),Introduction,Common cause of hospital admission following trauma High morbidity and mortality Craniocerebral injury is the leading cause of death in persons under 45 years of age. Main cause: Motor Vehicle Accidents (MVA) Other causes: falls; assaults,Directly injury: - injury of acceleration: coup injury -injury of deceleration: contrecoup injury -crush injury Indirectly injury: -transitivity injury -whiplash injury -thoraeic pressed injury traumatic apnea,injury of acceleration,injury of deceleration,crush injury,Whiplash injury,transitivity,traumatic apnea,classification of craniocerebral injury,Scalp injury Skull injury Brain injury Open injury and closed injury primary brain injury and secondary brain injury,Scalp injury,Scalp anatomy: (The scalp consists of five layer) Skin Subcutaneous tissue Galea Subgaleal space Pericranium or periosteum,Require attention,Scalp injury may be associated with trauma to the underlying bone,dura,or brain,or they may be isolated and involv the soft tissues only. Even simple lacerations to the scalp can result in signicant blood loss and hypovolemic shock.,Scalp lacerations Scalp avulsions Scalp hematoma subcutaneous hematoma subgaleal hematoma subperiosteal hematoma,Scalp hematoma Clinical characteristics,Skull injury,Cranial vault Linear skull fracture Depressed skull fracture Basal skull fracture,Linear skull fracture: alert intracranial hematoma,Depressed skull fracture,Indications for surgery: 1 cm depression(or thickness of skull) Deficit related to underlying brain Signs of increased intracranial pressure Open depressed fracture or CSF leak Seizure More conservative treatment is recommended for fractures overlying a major dural venous sinus,“ping-pong ball”fractures: Caving in of a focal area of the skull as in a crushed area of a ping-pong ball. Usually seen only in the newborn due to the plasticity of the skull.,Basal skull fracture,fracture of anterior fossa fracture of middle fossa fracture of posterior fossa,Presentation with basal skull fractures,Periorbital ecchymoses:raccoons,Postauricular ecchymoses ;battles sign,Diagnosis with basal skull fractures,CT scan is often poor directly demonstrating basal skull fracture. The diagnosis mainly depend on clinical Presentation of basal skull fractures,Treatment with basal skull fractures,Most do not require treatment by themselves. The routine use of antibiotics for 7-10 days. Other,Brain injury,Primary injury Cerebral concussion Cerebral contussion and laceration injury Brain stem injury Diffuse axonal injury Secondary brain injury Intercranial hematoma Brain edema,Cerebral concussion,Definition: a transient and immediate alteration of consciousness due to traumatic injury to brain Clinical presentation and diagnosis: 1.A trasient loss of consciousness, 30 min 2.Memory deficits 3.symptoms of neurofunction deficits 4.There are no gross parenchymal abnormalities,CT is normal,Management for cerebral concussion,May go home with head-injury instructions or admit to hospital according to concussion grading,Cerebral contussion and laceration injury,Clinical presentation and diagnosis: (Parenchymal damege) 1.Loss of consciousness: for several hours to several days or several months 2. Symptoms 3.Elevated ICP 4.Vital signs 5.Focal signs,Management for cerebral contussion and laceration injury,admit to hospital or NICU,Other primary injury,Brain stem injury Diffuse axonal injury Hypothalamus injury,Intracranial hematomas,Classification: location： epidural hematoma(EDH) subdural hematoma(SDH) intracerebral hematoma（ICH） time： Acute, subacute, chronic,Epidural hematoma(EDH),Epidural hematoma(EDH),Source of bleeding: the middle meningeal artery is the most common source,others:skull tracture, middle meningeal vein or dural sinus,Epidural hematoma(EDH),Presentation with EDH: 1.Loss of consciousness, “lucid interval” 2.Elevated ICP 3.Ipsilateral and contralateral pupillary alterations 4.Neurological system and vital signs,Management for EDH:,Nonsurgical or surgical management Admit and observe including follow-up CT Indication for surgery: 1.Symptomatic EDH 2.Elevated ICP or herniation 3. CT scanning: 1cm in its thickest measurement or 30ml in volume or midline shift 1cm,Surgery for intracranial hematoma,Subdural hematoma(SDH),Source of bleeding: surface vascular or bri