Head injury Head injury refers to trauma of the head.

This may or may not include injury to the brain.[1] However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature.[2] The incidence (number of new cases) of head injury is 300 of every 100,000 per year (0.3% of the population), with a mortality rate of 25 per 100,000 in North America and 9 per 100,000 in Britain. Head trauma is a common cause of childhood hospitalization.[citation needed]

Classification Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull. Head injuries may be closed or open. A closed (non-missile) head injury is where the dura mater remains intact. The skull can be fractured, but not necessarily. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area. A head injury may cause a minor headache skull fracture, which may or may not be associated with injury to the brain. Some patients may have linear or depressed skull fractures. If intracranial hemorrhage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy surgeries are used in these cases to lessen the pressure by draining off blood. Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to a contrecoup effect (the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact). If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull (both are contrecoup injuries).

Private Patrick Hughes, Co. K, 4th New York Volunteers, wounded at the battle of Antietam on September 17, 1862. Specific problems after head injury can include[citation needed]: Skull fracture Lacerations to the scalp and resulting hemorrhage of the skin Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull Traumatic subarachnoid hemorrhage Cerebral contusion, a bruise of the brain Concussion, a loss of function due to trauma Dementia pugilistica, or "punch-drunk syndrome", caused by repetitive head injuries, for example in boxing or other contact sports A severe injury may lead to a coma or death Shaken Baby Syndrome - a form of child abuse [edit]Concussion

Main article: Concussion Mild concussions are associated with sequelae. Severity is measured using various concussion grading systems. A slightly greater injury is associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In all cases the patients develop postconcussion syndrome, which includes memory problems, dizziness, tiredness, sickness and depression. Cerebral concussion is the most common head injury seen in children.[citation needed]

[edit]Intracranial hemorrhage Main article: Intracranial hemorrhage Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area. [edit]Intra-axial hemorrhage Main article: cerebral hemorrhage Intra-axial hemorrhage is bleeding within the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, and intraventricular hemorrhage, bleeding within the brain's ventricles(particularly of premature infants). Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds.[3] [edit]Extra-axial hemorrhage

Subdural v Hematoma type Epidural

d e

Location

Between the skull and the dura

Between the dura and the arachnoid

Temperoparietal locus (most likely) Middle meningeal artery Frontal locus - anterior ethmoidal Bridging veins Involved vessel artery Occipital locus transverse or sigmoid sinuses Vertex locus - superior sagittal sinus Symptoms Lucid interval followed by unconsciousness Gradually increasing headache and confusion Crescent-shaped

CT appearance Biconvex lens

Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:

Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma. It may result from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases in intracranial pressure can result rapidly. However, it is the least common type of meningeal bleeding and is seen in 1% to 3% cases of head injury . Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC) Head CT shows lenticular (convex) deformity.

Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. Head CT shows crescent-shaped deformity Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache (a thunderclap headache). This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention. [edit]Cerebral contusion

Main article: Cerebral contusion Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. Complications may include cerebral edema and transtentorial herniation. The goal of treatment should be to treat the increased intracranial pressure. The prognosis is guarded. [edit]Diffuse axonal injury Main article: Diffuse axonal injury Diffuse axonal injury, or DAI, usually occurs as the result of an acceleration or deceleration motion, not necessarily an impact. Axons are stretched and damaged when parts of the brain of differing density slide over one another. Prognoses vary widely depending on the extent of damage.

Sign and symtoms Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurologic deficit.

Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur. Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headache and a lucid interval, during which a patient appears conscious only to deteriorate later.[4] Symptoms of skull fracture can include:

leaking cerebrospinal fluid (a clear fluid drainage from nose, mouth or ear) may be and is strongly indicative of basilar skull fracture and the tearing of sheaths surrounding the brain, which can lead to secondary brain infection. visible deformity or depression in the head or face; for example a sunken eye can indicate a maxillar fracture an eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerve that innervates eye muscles wounds or bruises on the scalp or face. Basilar skull fractures, those that occur at the base of the skull, are associated with Battle's sign, a subcutaneous bleed over the mastoid, hemotympanum, and cerebrospinal fluid rhinorrhea and otorrhea.

Because brain injuries can be life threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation. The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms. The Glasgow Coma Scale is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Glasgow Coma Scale is used in young children. http://en.wikipedia.org/wiki/Head_injury

Intracranial Hemorrhage = cerebral hemorrhage

A cerebral hemorrhage or haemorrhage (or intracerebral hemorrhage, ICH) is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke. Nontraumatic intracerebral hemorrhage is a spontaneous bleeding into the brain tissue.[1] A cerebral hemorrhage is an intra-axial hemorrhage; that is, it occurs within the brain tissue rather than outside of it. The other category of intracranial hemorrhage is extra-axial hemorrhage, such as epidural, subdural, and subarachnoid hematomas, which all occur within the skull but outside of the brain tissue. There are two main kinds of intra-axial hemorrhages: intraparenchymal hemorrhage and intraventricular hemorrhages. As with other types of hemorrhages within the skull, intraparenchymal bleeds are a serious medical emergency because they can increase intracranial pressure, which if left untreated can lead to coma and death. The mortality rate for intraparenchymal bleeds is over 40%.[2]

Classification Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area. [edit]Intra-axial hemorrhage Main article: cerebral hemorrhage Intra-axial hemorrhage is bleeding within the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, and intraventricular hemorrhage, bleeding within the brain's ventricles(particularly of premature infants). Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds.[2] [edit]Extra-axial hemorrhage Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:

Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma. It may result from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases in intracranial pressure can result rapidly. However, it is the least common type of meningeal bleeding and is seen in 1% to 3% cases of head injury . Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC) Head CT shows lenticular (convex) deformity. Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. Head CT shows crescent-shaped deformity Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache (a thunderclap headache). This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention. [edit]Epidural hematoma

Main article: Epidural hematoma

Subdural v Hematoma type Epidural

d e

Location

Between the skull and the dura

Between the dura and the arachnoid

Temperoparietal locus (most likely) Middle meningeal artery Frontal locus - anterior ethmoidal Bridging veins Involved vessel artery Occipital locus transverse or sigmoid sinuses Vertex locus - superior sagittal sinus Symptoms Lucid interval followed by unconsciousness Gradually increasing headache and confusion Crescent-shaped

CT appearance Biconvex lens

Epidural hematoma (EDH) is a rapidly accumulating hematoma between the dura mater and the cranium. These patients have a history of head trauma with loss of consciousness, then a lucid period, followed by loss of consciousness. Clinical onset occurs over minutes to hours. Many of these injuries are associated with lacerations of the middle meningeal artery. A "lenticular", or convex, lens-shaped extracerebral hemorrhage that does not cross suture lines will likely be visible on a CT scan of the head. Although death is a potential complication, the prognosis is good when this injury is recognized and treated.[citation needed] [edit]Subdural hematoma Main article: Subdural hematoma Subdural hematoma occurs when there is tearing of the bridging vein between the cerebral cortex and a draining venous sinus. At times they may be caused by arterial lacerations on the

brain surface. Acute subdural hematomas are usually associated with cerebral cortex injury as well and hence the prognosis is not as good as extra dural hematomas. Clinical features depend on the site of injury and severity of injury. Patients may have a history of loss of consciousness but they recover and do not relapse. Clinical onset occurs over hours. A crescent shaped hemorrhage compressing the brain that does cross suture lines will be noted on CT of the head. Craniotomy and surgical evacuation is required if there is significant pressure effect on the brain.Complications include focal neurologic deficits depending on the site of hematoma and brain injury, increased intra cranial pressure leading to herniation of brain and ischemia due to reduced blood supply and seizures. [edit]Subarachnoid hemorrhage Main article: Subarachnoid hemorrhage A subarachnoid hemorrhage is bleeding into the subarachnoid spacethe area between the arachnoid membrane and the pia mater surrounding the brain. Besides from head injury, it may occur spontaneously, usually from a ruptured cerebral aneurysm. Symptoms of SAH include a severe headache with a rapid onset ("thunderclap headache"), vomiting, confusion or a lowered level of consciousness, and sometimes seizures.[3] The diagnosis is generally confirmed with a CT scan of the head, or occasionally by lumbar puncture. Treatment is by prompt neurosurgery or radiologically guided interventions with medications and other treatments to help prevent recurrence of the bleeding and complications. Since the 1990s, many aneurysms are treated by a minimal invasive procedure called "coiling", which is carried out by instrumentation through large blood vessels. However, this procedure has higher recurrence rates than the more invasive craniotomy with clipping.[3]

Signs and symtoms Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.[3] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.[3] Intracerebral hemorrhages are often misdiagnosed as subarachnoid hemorrhages due

to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma before the bleed is noticed.

Cause Intracerebral bleeds are the second most common cause of stroke, accounting for 3060% of hospital admissions for stroke.[1] High blood pressure raises the risks of spontaneous intracerebral hemorrhage by two to six times.[1] More common in adults than in children, intraparenchymal bleeds due to trauma are usually due to penetrating head trauma, but can also be due to depressed skull fractures. Acceleration-deceleration trauma,[4][5][6] rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor are additional causes. Amyloid angiopathy is a not uncommon cause of intracerebral hemorrhage in patients over the age of 55. A very small proportion is due to cerebral venous sinus thrombosis. Infection with the k serotype of Streptococcus mutansmay also be a risk factor, due to its prevalence in stroke patients and production of collagen-binding protein.[7] Risk factors for ICH include:[8]

Hypertension Diabetes Menopause Current cigarette smoking Alcoholic drinks (2/day)

Tramautic intracerebral Hematomas are divided into acute and delayed. Acute intracerebral Hematomas occur at the time of the injury while delayed intracerebral Hematomas have been reported from as early as 6 hours post injury to as long as several weeks. It is important to keep in mind that intracerebral Hematomas can be delayed because if symptoms begin to appear several weeks after the injury, concussion is no longer considered and the symptoms may not be connected to the injury.

Diagnosis Intraparenchymal hemorrhage can be recognized on CT scans because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain due to edema, and therefore shows up darker on the CT scan.

Treatment Treatment depends substantially of the type of ICH. Rapid CT scan and other diagnostic measures are used to determine proper treatment, which may include both medication and surgery. [edit]Medication

Antihypertensive therapy in acute phases. The AHA/ASA and EUSI guidelines (American Heart Association/American Stroke Association guidelines and the European Stroke Initiative guidelines) have recommended antihypertensive therapy to stabilize the mean arterial pressure at 110 mmHg. One paper showed the efficacy of this antihypertensive therapy without worsening outcome in patients of hypertensive intracerebral hemorrhage within 3 hours onset.[9] Giving Factor VIIa within 4 hours limits the bleeding and formation of a hematoma. However, it also increases the risk of thromboembolism.[10] Mannitol is effective in acutely reducing raised intracranial pressure. Acetaminophen may be needed to avoid hyperthermia, and to relieve headache.[10] Frozen plasma, vitamin K, protamine, or platelet transfusions are given in case of a coagulopathy.[10] Fosphenytoin or other anticonvulsant is given in case of seizures or lobar hemorrhage.[10] H2 antagonists or proton pump inhibitors are commonly given for stress ulcer prophylaxis, a condition somehow linked with ICH.[10]

Corticosteroids, in concert with antihypertensives, reduces swelling.[11] [edit]Surgery

Surgery is required if the hematoma is greater than 3 cm (1 in), if there is a structural vascular lesion or lobar hemorrhage in a young patient.[10] A catheter may be passed into the brain vasculature to close off or dilate blood vessels, avoiding invasive surgical procedures.[12] Aspiration by stereotactic surgery or endoscopic drainage may be used in basal ganglia hemorrhages, although successful reports are limited.[10] [edit]Other treatment

Tracheal intubation is indicated in patients with decreased level of consciousness or other risk of airway obstruction.[10] IV fluids are given to maintain fluid balance, using normotonic rather than hypotonic fluids.[10]

http://en.wikipedia.org/wiki/Cerebral_hemorrhage http://en.wikipedia.org/wiki/Intracranial_hemorrhage