Scalp abrasion, hematoma, wound - CLW (contused lacerated wound) or incised wound (due to sharp object mostly- like knife). There may be minor injury or underline major injury in brain.Scalp hematoma if do not suside may require aspiration or repeated aspirations.
There may be crack # of skull. If crack is long or passing through important skull areas like base or vertex than CT Scan of brain may be required. Skull #s are better seen on AP/LAT skull X-rays. CT Scan may be required. There may be depressed # of skull. Simple depress # (ie. without scalp wound) may not require surgery for elevation always. Compound depress # (with scalp wound) may usually require surgery.
Brain haemorrhage -
1. Extradural Haemorrhage (EDH)- The haemorrhage is outside dura but beneath skull and usually occours due to skull # or extradural blood vessel tare. If haemorrhage is big enough causing compression of brain, giving rise to signs of brain compression than it may be required to be surgically evacuated. Results are nice, with no or minimal residual defecit.
Subdural Haemorrhage (SDH)- Usually suggests more severe head injury, usually associated with brain contusion or haenorrhage. Close observation with conservative treatment or surgery my be required to decompress brain, with residual defects.
Intracrebral Haemorrhgae (ICH) or brain contusion/haemorrhage - More severe type of injury, may require observation or surgical intervention, with resultant residual defects.
Intraventricular Haemorrhage (IVH)- Bleeding in ventricle may be associated with ICH, and may require draining of ventricular fluid. Prognosis is guarded.
Subarachnoid haemorhage- (SAH) - Occours below arachnoid membrane of brain (coverings of brain). It may not cause much defecit.
Brain Concussion, Contusion or Haemorrhage - Where in concussion no apparent injury, recovery is near normal. In contusion & haemorrhage- more severe type of head injury, requiring treatment & may be opertion, with residual defecits.
Brain Edema -
May be mild or severe, may be associated with contusion or haemorrhages.
Diffuse axonal injury (DAI)-
Whole brain is injured, early CT Scan may be normal, later on MRI is positive. There may be long term mild to severe defecits.
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Early transfer to hospital after giving cervical collar (to prevent cervical spine injury) on hard board (to prevent other D-L spine injury), with care of ABC - i.e. Airway, Breathing, Circulation (blood loss- IV fluids). After immediate assesment of injury, treatment started & investigations (CT Scan of Brain, X-rays - spine, chest etc. blood tests). Surgery for head injury may be required immediately or later on if patient deteriorates.Proper diagnosis & treatment can save many patients & can give rise to lesser complications- defecits. Prevention is Better than Cure. Wear Helmet - for two wheelers & Seat belt for car travellers - is MUST.
Following symptoms depending upon injury may be present.
X-ray Cervico-Dorsal Spine, Dorso-Lumbar Spine, Lumbo-Sacral Spine - AP/LAT.
MRI of Cervial/Dorsal/Lumbar region.
CT Scan of Spine.