Any injury that results in trauma to the scalp, skull, or brain can be classified as a head injury.
It is estimated that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%).
Alcohol involvement is known to be present among 15%-20% of TBIs at the time of injury. Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability and socioeconomic losses in India and other developing countries.
There are various classifications of Traumatic Brain Injury:
Closed Skull fractures: Usually do not require any surgical intervention and can be managed conservatively unless they have concomitant intracerebral bleed. However, a linear skull fracture of petrous bone causing facial injury paresis may rarely need decompression of the nerve if the fragment is compressing the nerve. Similarly, fracture of the optic canal causing compression on the optic nerve may warrant decompression if the fracture fragment is causing pressure on the nerve.
Concussion: Concussional brain injury is a form of mild head injury usually due to a blow to the head resulting in transient impairment of cognition, memory and emotional misbehaviour. Usually patients recover completely in few hours to few days depending upon the impact speed and site of injury. The duration of retrograde amnesia is an indicator of the severity of head injury.
Intracranial Hemorrhages: Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury, that is, it occurs in a localized spot rather than causing diffuse damage over a wider area.
Extradural Hemorrhage: It occurs between the skull and the duramater and collects between them. It is usually associated with skull bone fractures and may not haver associated underlying brain injury. They have characterstic biconvex picture on imaging and have a good overall prognosis if operated early or could be detrimental depending on the site and size of the hematoma.
Subdural Hemorrhage: subdural haemorrhage (SDH), is usually associated with severe traumatic brain injury. Blood gathers between the dura mater, which adheres to the skull, and the arachnoid mater, which envelops the brain. The subdural hematomas are usually associated with severe underlying brain injury and cause significant brain edema .Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. Subdural hematomas are often life-threatening when acute. Chronic subdural hematomas, however, have better prognosis if properly managed.
Subarachnoid Hemorrhage: Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns.
Contusion: Contusion is bruise of the brain tissue. It occurs in about 20-30% of head injurys. The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Thus treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull.
Diffuse axonal Injury: Diffuse axonal injury (DAI) is one of the most common and devastating types of traumatic brain injury, meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and persistent vegetative state after head trauma. It occurs in about half of all cases of severe head trauma and also occurs in moderate and mild brain injury.The outcome