A head injury is an injury that causes trauma to the skull or brain. The term traumatic brain injury and head injury is often used interchangeably in medical literature. This broad classification includes nerve injury, bleeding, vascular injury, cranial nerve injury, and subdural hygiene, among many others. This classification can be further categorized as opening (translucent) or covering a head injury. It depends on whether the skull is damaged or not. Because head injuries include extensive injury coverage, there are many causes - including accidents, falls, physical attacks, or traffic accidents - which can cause head injuries. Many are small, but some can be severe enough to require hospitalization.
The number of new cases is 1.7 million in the United States each year, with about 3% of these incidents leading to death. Adults have head injuries more often than age groups caused by falls, motor vehicle accidents, colliding or being hit by objects, or attacks. Children, however, may experience head injuries from fall accidents or deliberate causes (such as being hit or shaken) leading to the hospital.
Unlike broken bones where the trauma to the body is noticeable, head trauma can sometimes be conspicuous or inconspicuous. In case of open head injury, the skull is fractured and broken by objects that make contact with the brain. This causes bleeding. Other obvious symptoms may be neurological. The person may become drowsy, behave abnormally, lose consciousness, vomit, develop severe headaches, have an unsuitable pupil size, and/or can not move certain parts of the body. While these symptoms occur as soon as a head injury occurs, many problems may develop later in life. Alzheimer's disease, for example, is much more likely to develop in someone who has suffered a head injury.
Video Head injury
Classification
Head injuries include injuries to the brain and other head parts, such as scalp and skull. Head injury can be closed or open. A closed (non-missile) head injury is where the dura mater remains intact. The skull can be cracked, but not necessarily. A penetrating head injury occurs when an object pierces the skull and pierces the dura mater. Brain injury may spread, occur in large areas, or focus, located in specific small areas. Head injuries can cause skull fractures, which may or may not be associated with injury to the brain. Some patients may have a linear skull fracture or depression. In case of intracranial hemorrhage, a hematoma in the skull may put pressure on the brain. Types of intracranial hemorrhage include subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy surgery is used in these cases to reduce the pressure by draining blood.
Brain injury can occur at the site of impact, but can also be on the opposite side of the skull due to the effects of contrecoup (impact to the head may cause the brain to move inside the skull, causing the brain to affect the inside of the skull across the head-impact ). If the effect causes the head to move, the injury may worsen, because the brain may bounce inside the skull causing additional impact, or the brain can remain relatively silent (due to inertia) but affected by a moving skeleton (both contrecoup) injury).
Specific problems after head injury may include
Konkusi
Traumatic brain injury (TBI) is the word exchange used for concussion. This term refers to mild brain injury. This injury is the result of a blow to the head that can make a person's physical, cognitive, and emotional behavior irregular. Symptoms may include irregularities, fatigue, confusion, nausea, blurred vision, headaches, and others. A mild concussion is associated with residual symptoms. Severity was measured using various concussion assessment systems.
A slightly larger injury is associated with anterograde and retrograde amnesia (inability to remember events before or after injury). The amount of time that amnesia is present correlates with the severity of the injury. In all cases the patient develops postconcussion syndrome, which includes memory problems, dizziness, fatigue, pain and depression. Cerebral concussion is the most common head injury seen in children.
Intracranial hemorrhage
The types of intracranial hemorrhages are roughly grouped into intra-axial and extra-axial. Bleeding is considered a focal brain injury; that is, it occurs in a localized place rather than causing widespread damage in a larger area.
Intra-axial bleeding
Intra-axial haemorrhage bleeds in the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, and intraventricular hemorrhage, bleeding in the ventricle of the brain (especially premature infants). Intra-axial haemorrhage is more dangerous and more difficult to treat than extra-axial bleeding.
Extra-axial bleeding
Extra-axial bleeding, bleeding that occurs inside the skull but outside the brain tissue, falls into three subtypes:
- Epidural hemorrhage that occurs between the dura mater (the outer meninx) and the skull, is caused by trauma. This can occur due to arterial laceration, the most common middle meningeal artery. This is a very dangerous type of injury because bleeding comes from a high pressure system and increased lethal intracranial pressure can occur quickly. However, this is the most unusual type of meningeal bleeding and is seen in 1% to 3% of cases of head injury.
- Patient loses consciousness (LOC), then clear interval, then suddenly regress (vomiting, anxiety, LOC)
- The CT head shows a lenticular (convex) deformity.
- Result of subdural hemorrhage from the tear of the bridging vein in the subdural space between the dura and the arachnoid mater.
- Head CT shows crescent shape deformities
- Subarachnoid haemorrhage, occurring between the arachnoid layer and the meningeal pia, such as intraparenchymal bleeding, may result from trauma or aneurysm rupture or arterial malformation. Blood is seen layering to the brain along with sulci and fissures, or filling the cistern (most often suprasellar cistern due to the presence of vessels from the Willis circle and their branchpoints in that space). The classic presentation of subarachnoid hemorrhage is a sudden onset of a severe headache (thunderclap headache). This can be a very dangerous entity, and requires the evaluation of neurosurgery, and sometimes urgent interventions.
Cerebral cuts
Brain splitting is a bruise on 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 increased intracranial pressure. Prognosis is maintained.
Diffuse axonal injury
A diffuse axon injury, or DAI, usually occurs as a result of the acceleration or deceleration movement, may not necessarily have an impact. Axons are stretched and damaged when parts of the brain from different densities shift to each other. The prognosis varies greatly depending on the extent of the damage.
Maps Head injury
Signs and symptoms
Presentations vary according to the injury. Some patients with head trauma are stable and other patients deteriorate. A patient may present with or without a neurologic deficit. Patients with concussions may have a history of minute to minute unconsciousness, then normal passion. Impaired vision and equilibrium can also occur. Common symptoms of head injury include coma, confusion, drowsiness, personality changes, seizures, nausea and vomiting, clear headaches and intervals, in which the patient appears conscious only to worsen later.
Symptoms of a skull fracture may include:
- The leaking of cerebrospinal fluid (a clear drainage of the nose, mouth or ear) may and strongly indicate a basilar skull fracture and a tearing of the casing surrounding the brain, which can lead to secondary brain infections.
- deformity or depression seen on the head or face; eg concave eyes may show maxillary fracture
- eyes that can not move or deviate to one side may indicate that the damaged face bone pinches the nerves that conserve the eye muscle
- cuts or bruises on the scalp or face.
- Basilar skull fractures, which occur at the base of the skull, are associated with Battle marks, subcutaneous bleeding over the mastoid, hemotympanum, and cerebrospinal fluid rinorea and otorrhea.
Because brain injury can be life-threatening, even people with minor injuries, without apparent signs or complaints, require close observation; They have an opportunity for severe symptoms later on. Carers with light trauma who are released from the hospital are often advised to wake the patient several times over the next 12 to 24 hours to assess the worsening symptoms.
Glasgow Coma Scale (GCS) is a tool for measuring the level of unconsciousness and is thus a useful tool for determining the severity of injuries. The Comedy Scale of Glasgow Children is used in small children. PECARN Pediatric Head Injury/Trauma The widely used algorithm helps physicians weigh the benefits of imaging risk in a given clinical setting of several factors about the patient - including the mechanism/location of injury, patient age, and GCS score.
Cause
Head injuries can be caused by a variety of reasons. All of these causes can be incorporated into the two categories used to classify head injuries; those that come from the impact (blows) and which occur because of trembling. Common causes of head injury due to collisions are motor vehicle crashes, home and work accidents, crashes, assaults, and sports-related accidents. Head injury due to shaking is most common in infants and children. According to the United States CDC, 32% of traumatic brain injuries (others, more specifically, the term for head injury) are caused by falling, 10% due to attack, 16.5% due to being hit by or against something, 17% by motor vehicle accident, and 21% in other unknown ways. In addition, the highest injury rate among children aged 0-14 years and adults aged 65 years and over.
Diagnosis
There are several methods used to diagnose head injury. A health care professional will ask patients questions about injuries as well as questions to help determine how the injury affects the function. In addition to this hearing, sight, balance, and reflex can also be assessed as an indicator of injury severity. A contrast head CT should be performed promptly in all people with mild or severe head injury. This is an imaging technique that allows doctors to look into the head without surgery to determine whether there is internal bleeding or swelling in the brain. Computed tomography (CT) has become the preferred diagnostic modality for head trauma because of its accuracy, reliability, security, and wide availability. Microcirculation changes, automatic regulatory disorders, cerebral edema, and axonal injury immediately after a head injury occur and manifest as clinical, biochemical, and radiological changes. MRI can also be performed to determine whether a person has abnormal growth or tumors in the brain or to determine whether a patient has a stroke.
Management
Most head injuries are benign and require no treatment other than analgesics such as acetaminophen. Steroid painkillers such as ibuprofen are avoided because they can make the potential for bleeding worse. Because of the high risk of even mild brain injury, strict monitoring for potential complications such as intracranial hemorrhage. If the brain has been severely damaged by trauma, a neurosurgical evaluation may be useful. Treatment may involve high intracranial pressure control. These may include sedation, paralytic, cerebrospinal fluid transfer. Second-line alternatives include decompressive craniectomy (Jagannathan et al.) Found 65% favorable outcome rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, no randomized studies have demonstrated clear benefits.
Doctors will often consult clinical decision support rules such as the CT Head of Canada Regulation or Head Injury New Orleans/Amal/Trauma Rules to decide whether the patient needs further imaging studies or observations only. Such rules are usually studied in depth by several research groups with large patient cohorts to ensure accuracy given the risks of side effects in this area.
Prognosis
In children with mild head injury without complications, the risk of intracranial hemorrhage over the next year is rare in 2 cases per 1 million. In some cases transient neurological disorders may occur, several minutes to hours. Malignant post-traumatic brain swelling can develop unexpectedly in stable patients after injury, such as being able to post a traumatic seizure. Recovery in children with neurologic deficits will vary. Children with improved neurological deficits each day are more likely to recover, while those who are vegetative for months tend to not improve. Most patients without a deficit experience a total recovery. However, people who suffer head trauma lead to unconsciousness for an hour or more have a double risk of developing Alzheimer's disease later in life.
Head injury may be associated with neck injury. Bruises on the back or neck, neck pain, or pain that radiate to the arm are signs of cervical spine injury and proper immobilization of the spine through the application of a cervical collar and possibly a long board.If this normal neurologic examination is reassuring. A reassessment is required if there is a worsening headache, seizures, one-sided weakness, or persistent vomiting.
To counter the excessive use of CT Scan Head which results in negative intracranial hemorrhage, which need not expose the patient to radiation and increase hospital time and travel costs, some clinical decision support rules have been developed to help physicians weigh the options for scanning patients with head injuries. Among these are the Canadian Head CT Principles, PECARN Head Injury/Trauma Algorithm, and New Orleans/Charity Head Injury/Trauma Rules all help doctors make this decision by using easily obtained information and non-invasive practices.
Epidemiology
Head injuries are the leading cause of death in many countries.
See also
- Traumatic brain injury
- Brain damage
- Konkusi
- Resulting in a brain injury
- Neurodegeneration
- Chronic traumatic encephalopathy
References
External links
- Brain Injury The official research journal of the International Brain Injury Association (IBIA)
- Cochrane Injuries Group: a systematic review of the prevention, treatment, and rehabilitation of traumatic injuries
- First aid advice for head injuries from the British Red Cross
- Mild head injury and concussion information from Headway - brain injury association
- Brain Injury Hub - practical information and advice for parents and family members of children with acquired brain injury
- Canadian CT Head Injury/Trauma Rule
- New Orleans/Charity Trauma/Injury Rule
- PECARN Pediatric Head Injury/Trauma Algorithm
Source of the article : Wikipedia
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