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Head Injury - Coggle Diagram

- - - - Focal
        
        Scalp - Contusion, laceration
        
        Skull - Fracture
        
        Meninges - Haemorrhage, infection
        
        Brain - Contusions, Laceration, infection
      - Diffuse Damage
        
        Brain
        
        DAI
        
        DVI
        
        HEI
        
        Cerebral oedema
  - - - Scalp laceration
      - Skull fracture
      - Cerebral contusions
      - ICH Intracranial haemorrhage
      - DAI Diffuse axonal injury
    - - Ischaemia
      - Hypoxia
      - Cerebral Oedema
      - Infection
- - - - Arterial
      - Haemorrhage into subarachnoid space
      - Spontaneous or traumatic aetiology
      - Trauma
        
        Severe contusions
        
        Fracture of skull can rupture vessels
        
        IVH may enter sub arachnoid space
      - Rule out aneurysm
      - Circle of Willis
    - - Venous
      - Rupture of bridging veins
      - May be acute, subacute or chronic
      - Common in children and older people
    - - 2% of HI
      - Usually associated with the skull
      - Arterial bleed
      - Classic History:
        
        Blow to the side of the head
        
        Lucid interval
        
        Deterioration
      - CT scan without contrast
        Epidural hematoma with right to left shift and ventricular compression
  - - - Neck pain 82%
      - Can be overlooked
    - - Traumatic dissection of vertebral artery
      - Thrombosis of vertebral or carotid arteries by hyperextention of the neck
      - Ischaemic brain damage
- - - - Primary Axotomy
        
        Refers to phycial disruption or tearing of axons
        Almost immediate effect
        
        Large axolemmal tears
        
        Influx of Ca2+
        
        Activation of calcium activated proteases
        
        Severe cytoskeletal disruption - degradation of proteins disrupts axon's integrity
        
        Effects
        
        Disconnection and disruption between parts of axon
      - Secodary Axotomy
        
        Ca2+ activated proteases focally damage the axon but immediate disconnection does not occur
        
        Failure of cellular repair mechanisms
        or
        Secondary neuronal damage
        
        Results in axonal disconnection
        
        Axoplasmic transport continues and results in proximal axonal swelling
  - - - Brain swelling and Raised ICP
        
        Cerebral vasodilation
        
        Increased cerebral blood volume
        
        Damage to blood vessels and escape of fluid through BBB
        
        Water conent of neurons and glia - cytotoxic
        
        Cerebral oedeam
- - - - At point of impact
    - - Diametrically opposite point of impact
    - - At point of impact between hernia
- - - - Lowered level of consciousness
      - Rising blood pressure
      - Cheynes Stokes breathing
      - Loss of pupillary responses
    - - Can be horrifying rapid
      - More prolonged – pulmonary oedema
      - Cerebral oedema
    - - Compression and Duret haemorrhages
- - - - Direct
      - Indirect
    - - 60-70% cervical
      - 25% thoracic
      - 6-15% lumba
    - - C1/2
      - C4-7
      - T11-L2
    - - Results from cord compression, contusion, laceration and haemorrhage
    - - Over several days
      - Involves physiological responses to trauma
      - Hypoxia
      - Ischaemia
    - - Lesions in Vert Colum
        
        Prolapsed disc
        
        Kyphoscoliosis
        
        Metastatic tumour
      - Spinal Extradural lesions
        
        Metastatic carcinoma
        
        Lymphoma
        
        Myeloma
        
        Abcess
      - Intradural Extramedullary lesions
        
        Meningioma
        
        Schwannoma
      - Intramedullary lesions
        
        Astrocytoma
        
        Ependymoma
        
        Cyst formation