Types of head Injury

Fractures occurring a the the base of the skull may involve breach of the dura and subsequent….

CSF LEAKAGE!

What is a risk of CSF leak?

Infection and herniation

Fractures at the base of the skull are called…

Basilar skull fractures

Major Bones in the base of the skull 

Sphenoid bone

Sella turcica

inferior portions of the frontal and tempral bones

What is the significance of the sella turcica?

it protects the PITUITARY GLAND

• Role in ADH → SIADH and DI risk

Hallmark sign of basilar skull fracture when the dura has been breached

Fluid from ear (middle fossa)

Fluid from nose (anterior fossa)

LATE sign of basilar fracture

Bruising around the eye (raccoon’s eye)

Bruising around the ear (Battle’s sign)

Where is an epidural hematoma located?

Blood collect in space between SKULL and DURA MATER

Emergency treatment of epidural hematoma

Prompt/immediate surgical EVACUATION of blood clot and repair of blood vessels

S/S of epidural hematoma

Varies from COMATOSE to LUCID (aware of surroundings)

“talk and die phenomenon” → progress to cerebral herniation (RAPID)

Where is a subdural hemotoma located?

Collection of blood BENEATH dura and above arachnoid

Risk of cerebral contusion (bruise on surface of brain)

Potential to transform into hematoma → cerebral edema

Important nursing action for cerebral contusion

serial NEUROLOGICAL assess → high degree of suspicion for deterioration → EARLY ID of increased ICP!

Struggles with Neuronal injury (Diffuse axonal injury)

Not easily visualized with CT or MRI because problem is at the CELLULAR level

Diffuse axonal injury

Direct injury to neurons due to shearing and rotational forcces

S/S of DAI

SYMPATHETIC STORMING!!!

• TACHYcardia

• TACHYpnea

• HYPERthermia

• Motor posturing (Flexor/extensor)

Traumatic Subarachnoid Hemorrhage

Poor prognosis in patients with TBI (deep in brain)

Disruption to veins and arteries traversing the arachnoid layer

What happens in Traumatic Subarachnoid Hemorrhage

Arterial dissection

Arterial Dissection

Disruption or tear to one or more of the blood vessel layers

Risk of the disruption of the intima (innermost layer)

Clot formation → occludes inner lumen

Can produce a flap of tissue → occludes artery → ischemic STROKE

S/S of arterial dissection

SUDDEN focal NEURO change

Neck pain

Horner’s Sign

Horner’s Sign

Ipsilateral (same side of injury)

• Miosis (pupil CONSTRICTION)

• Ptosis (eyelid droop)

• Anhidrosis (decrease in sweat)

Surgical Management of Skull Fracture

Wound Debridement

Removal of bone fragments

Risk of Skull Fx

Infections of CNS

• Meningitis

• Encephalitis

Craniotomy is used in patients with

Hemorrhagic (hematomas) injuries → open skull → remove blood