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Head Anatomy
Head Anatomy
Scalp
S: SkinC: Connective TissueA: The aponeurosisL: Loose areolar connective tissueP: The pericranium
Brain Anatomy
Cranial Nerves
I. Olfactory - Smell II. Optic - Vision III. Oculomotor – Eye movement, opening of eyelid, constriction of
pupil, focusing IV. Trochlear – Inferior and lateral eye movement V. Trigeminal – Sensation to face, mastication VI. Abducens – Lateral movement of eye VII. Facial – Facial expression, taste, control of tear, nasal, sublingual
salivary, and submaxillary glands VIII. Vestibulocochlear (Auditory) – Hearing and equilibrium IX. Glossopharyngeal – Swallowing, salivation, gag reflex, tongue and
ear sensation X. Vagus – Swallowing, speech, regulation of pulmonary, GI, and
cardiovascular functions XI. Spinal Accessory – Swallowing, trapezius, SCM XII. Hypoglossal – Tongue movement, speech, swallowing
Head Injuries
Skull Fx MOI: Blunt trauma Sx: Severe headache,
nausea, skull indentation, may be blood in the middle ear, blood in the ear canal, blood through the nose, ecchymosis around the eyes (“raccoon eyes”), ecchymosis behind the ear (“Battle’s Sign”), Cerebrospinal fluid may appear in the ear canal and nose
Complications arise from intracranial bleeding, bone fragments in the brain, and infection
Head Injuries
Concussion Immediate and transient posttraumatic impairment of neural
functions (ex: alterations of consciousness, vision disturbances, loss of equilibrium, etc.) due to brain stem involvement
Coup: injury occurs under the site of impact with an object Contrecoup: injury occurs on the side opposite the area that was
impacted
Head Injuries
Concussion Sx:
Confusion Amnesia (Anterograde, Retrograde) Headache Dizziness Ringing in the ears Nausea or vomiting Slurred speech Fatigue Memory or concentration problems Sensitivity to light and noise Sleep disturbances Irritability Depression Listlessness, tiring easily Irritability, crankiness Change in eating or sleeping patterns Loss of balance, unsteady walking
Head Injuries
Concussion Assessments Neurological Exam:
Cognitive function Cranial Nerve testing Coordination and Motor Function Sensory Testing Reflex Testing
Head Injuries
Concussion Assessments Eye Function
PEARL Blurred Vision Smooth tracking
Nystagmus – constant involuntary back and forth, up and down, or rotary movement of the eye
Head Injuries
Concussion Assessments Balance Tests
Romberg Test Balance Error Scoring
System (BESS)
Head Injuries
Concussion Assessments Coordination Tests
Finger-to-nose Heel-to-toe walking Indicate injury to the cerebellum
Cognitive Tests Serial 7’s (count down from 100 by 7) Spelling a word backwards Listing the months of the year in reverse order Test recent memory
Head Injuries
Concussion Assessments Standardized
Assessment of Concussion (SAC)
Head Injuries
Concussion Assessments ImPACT
Immediate Post-Concussion Assessment and Cognitive Testing Measures player symptoms Computer administered Can be administered on a lap-top for easy access and administration Assists physicians and athletic trainers in making difficult return-to-
play decisions Permits individual and group administration Provides reliable baseline test information Results can be E-mailed or Faxed for fast consultation by a
Neuropsychologist Produces comprehensive report of test results Automatically stores data from repeat testing Measures attention, memory, processing speed and reaction time Reaction time measured to 1/100th of second
Head Injuries
Home Care for Concussion It is OK to:
Use Acetaminophen (Tylenol) Use Ice packs Eat a light diet Sleep Rest
Head Injuries
Second Impact Syndrome Occurs because of rapid swelling and herniation of the
brain after a second head injury that occurs before the previous injury has healed
Sx: Stunned look, within 15-20 minutes the athlete’s conditions worsens with dilated pupils, loss of eye movement, loss if consciousness leading to coma, and respiratory failure
Mortality rate is approximately 50%
Head Injuries
Cerebral Contusion Small hemorrhages of intracranial bleeding within either the cortex,
brain stem, or cerebellum usually resulting from an impact force where the head strikes a stationary object
Sx: LOC but then becomes very alert and talkative. Normal neurological exam, headache, dizziness, nausea
Hospitalization and CT Scan or MRI
Head Injuries
Malignant Brain Edema Syndrome Young athletes In adults, this syndrome occurs due to intracranial
clots Diffuse brain swelling resulting from hyperemia
(blood congests in a particular area of the body) or vascular engorgement with little or no injury to the brain
Life-threatening consequences occur due to raised intracranial pressure with herniation
Sx: Alert state to coma and occasionally death in minutes-hours
Head Injuries
Epidural Hematoma Blow to the head that can
cause a tear of the meningeal arteries
Occurs extremely quickly Sx: LOC (most cases), severe
head pain, dizziness, nausea, dilation of one pupil, sleepiness Later stages: deteriorating
consciousness, neck stiffness, slower pulse and respiration, convulsions
Life-threatening Surgically relieved
Head Injuries
Subdural Hematoma Occurs more frequently than
epidural hematomas and are the most common cause of death in athletes
MOI: Acceleration/deceleration forces that tear vessels that bridge the dura mater and the brain
3 Kinds:Acute: Arterial bleedingAssociated with other brain and
skull injuriesChronic: Venous bleeding
Sx: Not likely to be unconscious, dilation of one pupil, headache, dizziness, nausea, sleepiness
Head Injuries
Migraine Headaches Last anywhere from 4 hours to as long as 72 hours More common in women Falling estrogen levels just before menstruation can cause a mnigraine Sx: throbbing/pulsating, may be located on one side of the head, person only wants
to lie down in a dark room and sleep, nausea, vomiting, sensitivity to light, smell, or sound, visual changes (bright flashing lights, colored zigzag lines, blind spots, loss of vision on one side), tingling or numbness in arms or legs
Precipitating factors: Premenstrual, menstrual, oral contraceptive pills, pregnancy, puberty, menopause,
hyperthyroidism, fever, anemia, rhinitis, changes in temperature or altitude, change in activity, alcohol especially red wine, chocolates, cheese, nuts, hot dogs, drugs (nitroglycerin, nitrates, indomethacin), blood pressure changes, sleep (too much, too little)
Head Injuries
Scalp Injuries MOI: usually blunt or penetrating trauma Sx: extensive bleeding
Head Injuries
Stroke Lack of oxygen to the brain Often caused by interrupted blood
flow from a clot or aneurism causing the blood vessels to burst
Can cause a coma, paralysis, speech problems, dementia
Sx: numbness or weakness is face, arm, or leg (especially on one side of the body), confusion, trouble speaking or understanding, vision differences in one or both eyes, slurred speech, trouble walking, dizziness, loss of balance and coordination, sever headache
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