Head injury 

Hello students and friends, today we are going to learn what is head injury, how it is caused, its mechanism of injury, classification, and management.

Let's discuss first what is a head injury?

• Head injury is also termed as traumatic brain injury.
• Head injury is caused by any external physical force.
• In traumatic brain injury, there is an impairment of the functioning of the body or cognitive abilities.
• Behavioral or emotional functioning also gets disturbed.
• The impairments are either temporary or permanent depending upon the type of head injury.

Mechanism of brain injury

The mechanism of head injury includes:

Acceleration: In this head is fixed and the object is moving.

• If the head is hit by a stick, in this stage the head is fixed and the stick is considered as a moving object.

Deceleration: In this, the head is moving but the object is fixed.

• In this case, we can consider the case of a car accident or hit by a wall.
• Here, the wall is the object and the head is moving.

Causes

1. Road traffic accident(50%)
2. By fall of injury(21%)
3. Violence and assaults(12%)
4. Sports(10%).

Traumatic brain injury

1. Contusion- Brushing type injury, blood from small blood vessels are leaked due to injury; the arterial supply to the brain starts leaking due to the indirect effect of trauma.
2. Concussion- It is a mild traumatic injury; in this type of injury brain is hit in the cranial cavity or skull, the term used for this type of injury is the jarring type of injury.
3. Countre coup injury- It is also a jarring type of traumatic injury but in this case, injury occurs to the opposite side means when there is any condition in which the brain gets hit by the skull, then the opposite side of the brain gets injured.

Signs and symptoms

Symptoms gradually develop over 1-6 weeks.

1. CSF leakage from ears and nose.
2. Minor blunt head injury.
3. Penetrating trauma.
4. Increase in ICP(intracranial pressure).
5. Positive Babinski's sign(indicate upper motor neuron lesion).
6. Raccoon eyes.
7. Ecchymosis below the ear(battle sign).
8. Loss of consciousness.
9. Vomiting and nausea.
10. Persistent headache which gets worsens with time.
11. Seizures and convulsions.
12. Confusions
13. Personality changes
14. Mild paralysis.
15. Memory loss.
16. Loss of hearing or eyesight.
17. Dizziness or vertigo.
18. Peripheral nerves are often injured which leads to numbness and tingling.
19. Coordination problems.
20. Aphasia.

Fracture of the skull in head injury

There are 4 types of fractures seen in head injury patients-

1. Linear fracture
2. Depressed fracture
3. Diastatic fracture
4. Basilar fracture.

Linear Fracture: Most common type of skull fracture during a head injury.

• In this type of fracture, depression is not seen.
• There is a simple break in the skull that follows a simple straight line in the skull.
• Not a serious injury.

Depressed Fracture: Type of comminuted fracture.

• There is a breakage in the bone into many parts.
• Depression is also seen at the site of fracture.

Diastatic Fracture: It is seen commonly in young children.

• Fracture of sutural line.
• Cause pits in the bone of the skull.
• The fracture occurs on one or more sutures.

Basilar Fracture: It is the most severe type of fracture.

• Usually caused by severe blunt head trauma.
• In the basilar type of fracture, fracture of the base forming bone.
• Mostly temporal bones are involved.
• It also involves occipital, sphenoid, ethmoid, and frontal bone(orbital plate).

Management 

• If there is an increase in ICP(intracranial pressure) then we have to alter the patient's position for maintaining ICP.
• The flat supine or prone position of the patient must be avoided.
• To decrease intracranial pressure, osmotic diuretics(mannitol 20%) is administered.
• If CSF(cerebrospinal fluid) production increase, then acetazolamide and glycerol is administered which decreases the production of CSF and increases its absorption.
• Nose blowing and coughing must be avoided because they increase intracranial pressure.
• Surgeries[craniotomy, craniectomy, and burr holes].

Indications

1. Large hematomas
2. The patient is in a coma.
3. CT-scan shows midline shifts.
4. Rapid deterioration.

Complications of brain surgeries

1. Infections(meningitis).
2. Chances of damage to the surroundings parts or structures.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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