1. Concussion and Other Head
Injuries
BY: DR.KUCHA

2. Concussion
• refers to an immediate but transient loss of
consciousness that is associated with a short
period of amnesia.
• The mechanics of concussion involve a blunt
forward impact that creates sudden
deceleration of the head and an anterior-
posterior movement of the brain within the
skull.

3. Contusion, Brain Hemorrhage, and
Axonal Shearing Lesions
• Contusion: consists of varying degrees of
petechial hemorrhage, edema, and tissue
destruction.
• The clinical signs are determined by the location
and size of the contusion.
• A hemiparesis or gaze preference is fairly typical
of moderately sized contusions.
• Large bilateral contusions produce coma with
extensor posturing, while those limited to the
frontal lobes cause a taciturn state.

4. • Contusions in the temporal lobe may cause
delirium or an aggressive, combative
syndrome.
• Contusions are easily visible on CT and MRI
scans, appearing as inhomogeneous
hyperdensities on CT and as hyperintensities
on MRI.

5. Subdural and Epidural Hematomas
• Acute Subdural Hematoma:
• most patients with ASH are drowsy or
comatose from the moment of injury.
• Direct cranial trauma may be minor and is not
required for ASH to occur.
• Acceleration forces alone, as from whiplash,
are sometimes sufficient to produce subdural
hemorrhage.

6. • Stupor or coma, hemiparesis, and unilateral
pupillary enlargement are signs of larger
hematomas.
• Small subdural hematomas may be
asymptomatic and usually do not require
evacuation.

7. • On imaging studies subdural hematomas appear
as crescentic collections over the convexity of
one or both hemispheres, most commonly in the
frontotemporal region, and less often in the
inferior middle fossa or over the occipital poles.
• The bleeding that causes larger hematomas is
primarily venous in origin, although additional
arterial bleeding sites are sometimes found at
operation and a few large hematomas have a
purely arterial origin.

8. SUBDURAL HEMATOMA

9. • Epidural Hematoma:
• These evolve more rapidly than subdural
hematomas and are correspondingly more
treacherous.
• Most patients are unconscious when first
seen. A "lucid interval" of several minutes to
hours before coma supervenes is most
characteristic of epidural hemorrhage.

10. EPIDURAL HEMATOMA • The tightly attached dura is
stripped from the inner
table of the skull,
producing a characteristic
lenticular-shaped
hemorrhage on
noncontrast CT scan.
• Epidural hematomas are
usually caused by tearing of
the middle meningeal
artery following fracture of
the temporal bone.

11. .

12. • Chronic Subdural Hematoma:
• A history of trauma may or may not be elicited in
relation to chronic subdural hematoma. The
causative injury may have been trivial and
forgotten; 20–30% of patients recall no head
injury.
• CLINICAL FEATURES:
• features may include slowed thinking, vague
change in personality, seizure, or a mild
hemiparesis.
• The headache may fluctuate in severity.
• Bilateral chronic subdural hematomas produce
perplexing clinical syndromes.

13. Grading and Prognosis
• In severe head injury, the clinical features of
eye opening, motor responses of the limbs,
and verbal output have been found to be
generally predictive of outcome.
• These three features are summarized in the
Glasgow Coma Scale (GCS).

14. Glasgow Coma Scale for Head Injury
Eye opening (E) score
Spontaneous 4
To loud voice 3
To pain 2
Nil 1

15. Best motor response (M) score
Obeys 6
Localizes 5
Withdraws (flexion) 4
Abnormal flexion 3
posturing
Extension posturing 2
Nil 1

16. Verbal response (V) Score
Oriented 5
Confused, disoriented 4
Inappropriate words 3
Incomprehensible sounds 2
Nil 1

17. • Coma score = E + M + V.
• Patients scoring 3 or 4 = 85% chance of dying
or remaining vegetative.
• scores >11 = 5–10% likelihood of death or
vegetative state and 85% chance of moderate
disability or good recovery.
• Intermediate scores correlate with
proportional chances of recovery.

18. Thank you…