Head trauma [Neurosurgery Wiki]

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====== Head trauma ======
===== Head Trauma vs Traumatic Brain Injury (TBI) =====

{{tag>neurotrauma_tbi_head_trauma_emergency}}

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==== 🩹 What is Head Trauma? ====
**Head Trauma** refers to **any injury** involving the **scalp, skull, or brain**.

It includes:
  * Scalp wounds
  * Skull fractures
  * Brain injuries (like TBI)

🧾 It **does not always affect brain function** and may be minor (e.g., bump, bruise).
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==== 🧠 What is Traumatic Brain Injury (TBI)? ====
**TBI** is a **specific** type of head trauma where there is **actual damage to the brain**.

It involves:
  * Disruption of brain function
  * Possible symptoms: loss of consciousness, confusion, memory issues
  * Severity levels:
    - Mild (e.g., concussion)
    - Moderate
    - Severe (e.g., diffuse axonal injury, contusion)

📌 TBI **always** implies brain involvement.
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===== 🧠 Summary Table =====

^ Term ^ Scope ^ Brain Involvement ^ Examples ^
| **Head Trauma** | Scalp, skull, or brain | Not necessarily | Scalp laceration, skull fracture |
| **[[Traumatic Brain Injury]]** | Brain-specific injury | Always | Concussion, cerebral contusion, DAI |

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''All TBIs are head trauma, but not all head trauma is TBI.''




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25% have “surgical” lesions. There is a 4–5% [[incidence]] of associated [[spine fracture]]s 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 =====

see also [[Traumatic brain injury complications]].

[[Acute subdural hematoma]]

[[Cephalhematoma]]

[[Chronic subdural hematoma]]

[[Concussion]]

[[Deep-vein thrombosis]]: especially severe [[TBI]]

[[Disseminated intravascular coagulation]]

[[Delayed deterioration]]

[[Epidural hematoma]] 

[[Hemorrhagic contusion]]

[[Post-traumatic hearing loss]]

[[Posttraumatic hydrocephalus]]

[[Posttraumatic seizures]] 

[[Pulmonary embolism]]

[[SIADH]] 4.6% prevalence

[[Skull fracture]]

[[Tension pneumocephalus]]

[[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
((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.
)).