Head Injuries

Basic Anatomy:
Bones:
1. Skull:
Frontal
Parietal
Temporal
Occipital
Maxilla
Mandible
Nasal
Zygomatic Arch
Lacremal

2. Brain:
Meninges: 3 layers of nonnervous tissue that surrounds and protects the brain and spinal cord.
1. Dura Mater: Tough, fibrous membrane, outermost layer
2. Arachnoid Mater: Thin, cellular membrane similar to spider web, inner layer
3. Pia Mater: Innermost layer, meshwork of connective tissue strands, covers the brain, subarachnoid space seperates the pia mater from the arachnoid mater

Cerebrum: Largest portion of the brain
1. Large mass of nervous tissue distinguished by folds of convolutions.
2. 2 Hemisphers
3. 4 Lobes: Frontal, Temporal, Parietal, and Occipital

Brain Stem:
1. Decends from the base of the brain
2. The diencephalon forms the upper portion of the stem

Gray Matter: Composed of a majority of nerve cells; controls the highest mental & behavioral activities; speech, motor, & sensory functions; outer posrtion of the brain

Pons: Controls sleep, posture, respirations, swallowing, and bladder

Medullar Oblongata: Lowest part of the brain stem
1. Regulates heart rate, repirations, BP, coughing, sneezing, and vomiting

Cerebellum:
1. Regulates movement & posture
2. Functions in conjuction with the cerebrum and brain stem

Cerebrospinal Fluid
1. Serves as a liquid cushion for the brain and spinal cord
2. Filters through the venticular and subarachnoid space

Concussion

Grade 1/Mild:
Signs & Symptoms: No loss of consciousness
Mild nausea
Mild headache
Memoory loss may occur
Tinnitus(Rining in the ears) may occur
Dizziness
Mild Confussion
Decreased coordination may occur
Pupils/Vision Normal

Treatment:
Discontinue activity
Monitor signs & symptoms
Physician should evaluate
Physician determines return to play
*Athlete is Sx free before return to play

Grade 2:
Signs & Sx:
Refer to Grade 1, but intensify
Loss of consciousness for less than 2 minutes
Vomiting

Treatment:
Refer to Grade 1

Grade 3
Signs & Sx:
Refer to Grade 2 but intensify
Loss of consciousness for greater than 2 minutes
Projectile vomiting
Mass confusion
Hematoma may be present
Skull Fx may be associated

Treatment:
Refer to Grade 2
Hospitalization
Register w/ Head & Neck Registry with 3+ night stay
Possibly season ending

Skull Fractures

Types of Skull Fx's
Linear: In a line
Depression: Fragments are driven toward the brain
Communted: Multiple peices
Basilar: Involving the base of the skull
Blow Out Fx: Involving the eye orbit

Signs & Sx
Racoon Eyes: Anterior cranial fossa & sinuses leading to discoloration around the eyes
Blood or Cerbrospinal Fluid coming from the nose &/or ears
Battle's Sign: Basilar Fx, discoloration behind the ears
Hearing Loss
Visual Deformity
Deep lacerations or contusions
Paralysis
Unequal pupils
Unconsciousness





Management for Skull Fx's
1. Stabilize the head & neck
2. Check A,B,C's
3. Activate EMS
4. Take vitals at least every 5 minutes
5. Cover any open wounds
6. Treat for shock
7. Remain calm, if you do, they usually will

Cerbral Mematomas
1. Epidural Hematoma:
Mech: Usually a direct blow to the side of the head
Skull Fx usually associated
They may seem "normal" for some time, but after 10-20 minutes signs & Sx for neurologic deterioration will occur.
Typical signs & Sx for a concussion
Muscular weakness
Immediate surgery to decompress the hematoma

Subdural Hematoma
Occurs deep to the dura mater
Direct blow to the side of the head causing a contrecoup injury
*Contrecoup: The brain is thrust against the opposite side of the skull in relation to the direct blow.
This hematoma usually develops very slowly
Signs & Sx may not occur for several hous, days, or even weekns after the injury
Brain injury is usually associated with this injury
Usually loss of consciouness
Dialated Pupils
Decreased pulse
Vomiting
Dyspnea: Shortness of breath or difficulty breathing