logo-LF_red_1500 Injury of head, spinal cord and peripheral nerves logo Traumacentrum —Head injury - scalp injury — - cranial vault fractures - fissuration — - impression — - cranial base fractures — Brain injuries - diffuse - concussion — - diffuse axonal injury — - bearing - brain contusion — - compression - SDH, EDH, SAH, hygroma Head injury 1.scalp injury : 5 layers : skin - subcutaneous tissue– epicranial muscles – galea aponeurotica – pericranium —th: shaving– blood vessels ligation – hemostatic suture – compression - - - - - - - - - C:\Users\Magda\Desktop\Fotografie0235.jpg 2.cranial vault fractures —a) linear fx = fissuration —blunt hit —RTG - CT —conservative th —observation ! (IC complic) http://radiographics.rsna.org/content/23/4/811/F33.medium.gif b)Impressive fx —fragments impression– compression of dura mater and brain —surgery: dislocation more than the width of the bone http://images.radiopaedia.org/images/1670310/0bf79f41ccb7e6a083584ab41e500c.jpg http://ars.els-cdn.com/content/image/1-s2.0-S096758680500408X-gr6.jpg 2.cranial base fractures —Together with injury of brain basal parts = hypothalamus and brain stem ! —Periorbital – subkonjuctival haematoma —Frontobasal injuries — - injuries of face and cranial base together — - fx of o frontalis, ethmoidalis, sphenoidalis — - rinorea – otorea - pneumocefalus — - meningitis /ATB!/ — — Brain injuries —Anamnesis —vegetative symptomatology– cefalea, vertigo, nausea, vomitus —unconsciousness - consciousness disorder - amnesi 1.Diffuse injuries —Acceleration - decceleration a)Concussion •Functional disorder of CNS - no anatomic disability = stretching axonal bodies without structural laesions •consciousness disorder, amnesia, vegetative symptoms •Observation - monitoring /48h/ b)DAI /diffuse axomal injury/ —Multiple cutting interruptions of axons in white matter —Diverse (complete healing ~ shearingh injury = brain death) —undiagnostic CT!!! /dg post mortem/ —Monitoring, conservative th 2.bearing - brain contusion — bounded macroscopis injury of brain tissue —Symptoms by location : a)Edematous form b)Hemorhagic forme c)Dilaceration form — —Conservative therapy http://images.radiopaedia.org/images/1009028/7a885db8286da47b7ae8e7b4dba7e0.jpg http://2.bp.blogspot.com/-AY5iJyhsCXg/TVNi-tx2c7I/AAAAAAAAACA/o0BVxisRFpI/s1600/brain.jpg http://www.merckmanuals.com/media/home/figures/NEU_bursts_breaks_stroke.gif http://www.radiologytutorials.com/getimage.cgi?i=bilder/2/197-1&r=1400 3.Brain compression —The cause is brain oppression by intracranial bleeding — a)EDH —a. meningica media rupture —„lucide interval“ —CAVE! Alkoholic intoxication —anizokoria /mydriasa/ - extremities paresis —rtg – CT – surgery http://2.bp.blogspot.com/_OwoEg7Db_AE/TQ8ETKa89DI/AAAAAAAABF4/UTgS_GnN1vM/s1600/heamtoma.png http://www.merckmanuals.com/media/home/figures/PHY_pockets_blood_brain_head_injury.gif http://www.anesthesia2000.com/BrainInjury/epidural_hematoma1.jpg http://drugline.org/img/term/hematoma-extradural-6920_2.jpg b)SDH —Acute - acute – hours to days , brain sinuses injuries, bridging veins —subacute – max 3 weeks, venous bleeding —chronic – months, in atrophic brain, less bleedind of brindging veins — http://2.bp.blogspot.com/_OwoEg7Db_AE/TQ8ETKa89DI/AAAAAAAABF4/UTgS_GnN1vM/s1600/heamtoma.png http://www.merckmanuals.com/media/home/figures/PHY_pockets_blood_brain_head_injury.gif http://upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Subduralandherniation.PNG/230px-Subduralan dherniation.PNG http://rad.usuhs.edu/medpix/include/medpix_image.php3?imageid=17256 c)SAH —Injury of cortex vessels, poranění cév mozkové kůry, pinal and diploic vessels —Cefalea, fever —CT http://www.merckmanuals.com/media/home/figures/NEU_bursts_breaks_stroke.gif http://www.radiologytutorials.com/getimage.cgi?i=bilder/2/197-1&r=1400 d)Subdural hygroma —unencapsulated liquor accumulation in subdural space after arachnoid rupture —Hygrom can occur either early or after a long period —headache and impaired consciousness —CT , surgery in compression