UNIVERSITY OF BAGHDADCOLLEGE OF MEDICINE

DEPARTMENT OF SURGERY

NEUROSURGERY LECTURES

Prof. Dr. Ali Al-Shalchy

M.B.CH.B F.IC.S M.R.C.S F.R.C.S

HEAD INJURY

CLASSIFICATION OF HEAD INJURY (H.I.)

1 -Blunt injuryA-Acceleration injuryB-Decceleration injury

C-Acceleration-Decceleration injury

D-Rotational injury

2-Penetrating injury

SIGNS OF A H.I.

CLOSED H.I.

MECHANISMS OF CLOSED H.I.

OPEN H.I.

DAMAGE CAUSED BY H.I.

1-Primary2-Secondary

A-InfectionB-Brain oedema

C-Intracranial hemmorhage (I.C.H.)

BRAIN INFECTION (ABSCESS)

NORMAL & OEDAMATOUS BRAIN

I.C.H.

MANAGEMENT Of H.I.Investigations

1-Skull X-ray2-CT-Scan

3-MRI4-Angiography, EEG

CT-SCAN MACHINE

MRI MACHINE

MANAGEMENT OF NON COMPLICATED H.I.

-Indications for admission of a patient with H.I: .

1.loss of consciousness2.skull fracture(s)

3.neurological deficit4.medical diseases

5.convulsion following head injury6.persistant headache and vomiting

7.doubtful cases

Line of management runs in three lines1-ObservationA-Level of consciousnessB-PupilC-Vital signsD-CNS signs (focal signs)

Level of consciousnessGlascow coma scale

COMMENT SCORE ASSESSMENT AREA

Best possible score is 15, worst possible

is 3.

4321

Eye Opening (E) -Spontaneous

-To speech - To pain

- None

654321

BEST Motor Response (M) - Obeys commands- Localizes pain- Normal flexion (withdrawal)- Abnormal flexion (decorticate)- Extension (decerebrate) - None (flaccid)

54321

Verbal Response (V)- Oriented- Confused conversation- Inappropriate words- Incomprehensible sounds- None

Glasgow Coma Scale

MANAGEMENT ACCORDING TO

SEVERITY

UNEQUAL SIZED PUPILS

2-Nursing care A-Airway

B-Management of restless patientC-Sphinctor care

D-Skin careE-Feeding

F-Antibiotics

AIRWAY PIECES

ENDOTRACHEAL TUBE

ENDOTRACHEAL INTUBATION

INTUBATED SEVERELY H.I. PATIENT

TRACHEOSTOMY

TRACHEOSTOMY TUBE CARE

MECHANICAL VENTILATION

BED SORES (PRESSURE ULCERS)

TYPES OF NUTRITION

NG-TUBE

NG-TUBE

GASTROSTOMY TUBE

3-Indications for surgeryA-Simple stiching

B-Open H.I. (Penetrating)C-I.C.H.

SUTURED SCALP WOUND

SURGERY FOR A DEPRESSED SKULL FRACTURE (CRANIECTOMY)

SURGERY FOR AN ACUTE SDH (CRANIOTOMY)

THANK YOU