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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
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