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head_trauma

Head trauma

see Traumatic brain injury.


25% have “surgical” lesions. There is a 4–5% incidence of associated spine fractures with a significant head injury (mostly C1 to C3).

Differential diagnosis

When a detailed history is unavailable, remember: the loss of consciousness may have preceded (and possibly have caused) the trauma. Therefore, maintain an index of suspicion for e.g. aneurysmal subarachnoid hemorrhage, hypoglycemia, etc. in the differential diagnosis of the causes of trauma and associated coma.

Complications

Acute subdural hematoma

Cephalhematoma

Chronic subdural hematoma

Concussion

Deep-vein thrombosis: especially severe TBI

Disseminated intravascular coagulation

Delayed deterioration

Epidural hematoma

Hemorrhagic contusion

Posttraumatic hydrocephalus

Pulmonary embolism

SIADH 4.6% prevalence

Skull fracture

Traumatic brain edema

Traumatic brain injury

Traumatic intracerebral hemorrhage

Traumatic subdural hygroma.

Case series

The value of skull radiography in identifying intracranial injury has not yet been satisfactorily defined. A multidisciplinary panel of medical experts was assembled to review the issue of skull radiography for head trauma. The panel identified two main groups of patients–those at high risk of intracranial injury and those at low risk of such injury–and developed a management strategy for imaging in the two groups. The high-risk group consists primarily of patients with severe open or closed-head injuries who have a constellation of findings that are usually clinically obvious. These patients are candidates for emergency CT scanning, neurosurgical consultation, or both. The low-risk group includes patients who are asymptomatic or who have one or more of the following: headache, dizziness, scalp hematoma, laceration, contusion, or abrasion. Radiographic imaging is not recommended for the low-risk group and should be omitted. An intermediate moderate-risk group is less well defined, and skull radiography in this group may sometimes be appropriate. A prospective study of 7035 patients with head trauma at 31 hospital emergency rooms was conducted to validate the management strategy. No intracranial injuries were discovered in any of the low-risk patients. Therefore, no intracranial injury would have been missed by excluding skull radiography for low-risk patients, according to the protocol. We conclude that use of the management strategy is safe and that it would result in a large decrease in the use of skull radiography, with concomitant reductions in unnecessary exposure to radiation and savings of millions of dollars annually 1).

1)
Masters SJ, McClean PM, Arcarese JS, Brown RF, Campbell JA, Freed HA, Hess GH, Hoff JT, Kobrine A, Koziol DF, et al. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med. 1987 Jan 8;316(2):84-91. PubMed PMID: 3785359.
head_trauma.txt · Last modified: 2020/04/24 12:35 by administrador