head injury pathphysilogy and radilogical evaluation

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drvipan on Mar 19, 2011 Says :

pathophysilogy of head injury,,diff b/w 1/2 injury with complete notes of explanations

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Slide 1 :

Pathophysiology & Radiological Evaluation Head Injury Dr Vipan Kumar Resident Surgery, AHRR

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Introduction Initial injury is tear, shear and hemorrhage followed by a delay then onset of secondary insult. Traumatic brain injury following the initial insult sets in motion a sequence of pathological events that are delayed and progressive.

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Head Injury-Normal Physiology Brain consumes 20% of total O2 (3.5 ml/100gm/min Receives 15% of Cardiac Output (55 ml/100gm/min) 90 % energy requirements – blood born Glucose CPP versus CBF - Normal ICP 08-12 mm of Hg CPP=MAP-ICP MAP=(SBP-DBP/3) + DBP CPP should be maintained > 65 mm of Hg Auto-regulation MAP 50-150 mm Hg

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Head Injury-Pathophysiology Primary injury Irreversible cellular injury as a direct result of the injury Impact - Extradural, Subdural, Contusion, Intracerebral Hemorrhage, Skull Fracture Inertial - Concussion syndromes, Diffuse Axonal Injury Secondary injury Damage to cells that are not initially injured Occurs hours to weeks after injury

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Radiological Evaluation of TBI NCCT HEAD / X-RAY SKULL Skull films ineffective as trauma screen 1/3 of patients with severe brain injury – don’t have # Fracture can be linear, depressed, diastatic – missed on X-ray Scanning all pts ????

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NICE GUIDELINES FOR NCCT HEAD IN TBI GCS < 13 at any point GCS 13 or 14 at 02 hrs Focal neurological deficit Suspected open, depressed or basal skull # Seizure Vomiting > 01 episode Urgent CT scan if none of above BUT: Age > 65 yrs Coagulopathy (e.g. on warfarin, antiplatelets) Dangerous mechanism of injury (CT with in 08 hrs) Antegrade amnesia (CT with in 08 hrs)

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EDH

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SUBDURAL HEMATOMA

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Acute/Subacute/Chronic SDH

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SAH

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Intracranial hemorrhage

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Intraventricular hemorrhage

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Cerebral swelling

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Pneumocephalus

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Diffuse axonal injury

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	drvipan 2 Years ago.



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