Analysis of cranio-cerebral injuries by blunt force.

Despite current advances in public education and in automobile safety requirements, cranio-cerebral injuries continues to be a major cause of morbidity and mortality and accounts for significant portion of health care costs today. Trauma respects neither geography nor body systems. Consequently head injury occurs every 15 seconds and a patient dies from a head injury every 12 minutes, a day doesn’t pass that an emergency department physician is not confronted with a head injured patient. The present work is based on the observation and study made on 117 cases collected. These cases include 39 cases who died before being admitted to any hospital and were sent directly by the police to postmortem, Mysore Medical College, Mysore, and 78 cases that died in the hospital under medical care. Clinical data are available for 78 cases that died in the hospital after undergoing some treatment. An attempt is made in these cases to correlate clinical findings with the autopsy findings.

The management of cranio-cerebral injuries

1. The main bulk of the lesions of the central nervous system that require emergency treatment are produced by trauma. However, there are other non-traumatic lesions that are also emergencies because they are capable of producing the death of the patient if not immediately treated, such as infections (brain abscess), neoplastic and vascular lesions2. Before treatment can be instituted the proper diagnosis must be established. The cerebral angiogram and the ventriculogram are two of the most helpful diagnostic procedures in these problems3. The basic principles in the management of acute head injuries remain unchanged. These are: treatment of shock, control of hemorrhage and provision of an adequate airway; these should receive priority before any other treatment4. Routine use of hypertonic solutions, hypothermia and steroids in acute cranio-cerebral injuries should be avoided because intracranial expanding hematomas

A study of 114 cases of craniocerebral injuries

The number of cases herein presented is not reallly a big one, but there are points in this study which by way of induction are salient enough to constitute as guideposts whenever a case of cranio-cerebral injury is referred for treatment. They are the following: First, after a slight concussion an assurance can be given to the patient that his case will have no complication or sequelaeSecond, serial manometric and fundoscopic studies do not imply the presence of cerebral edema in case of severe concussion under our present laboratory facilitiesThird, for a linear fracture to occur, the symptoms that seemingly could be least expected are those of severe concussion. This is illustrated in this study when, combining the cases of purely linear fractures of the vault and the severed concussions, 19 cases resulted and 7 of these had linear skull fractures. It is always wise, therefore, to request for skull X-rays when there are symptoms manifesting a case more serious than slight cerebral concussionFourth, a serious development could be expected after cerebral contusion. In this study two of the 25 died. This is to be expected because edema always follows a contusion and cerebral edema can never spread beyond the confines of the unyielding calvarium. Beyond this, the edema may either subside by some therapeutic means or it may mean death to the patient. A peculiarity of this group is the attendant difficulty in its diagnosis, so much so that burr holes or a carotid arteriography must have to be made in some cases so that the diagnosis can be establishedFifth, basal fractures when multiple always spell a bad prognosis even under ideal management. The prognosis is worse when such injury is accompanied by other injuries located elsewhere in the bodySixth, an extradural hemorrhage always poses an imminent threat to a patient. This is the type of injury that very often eludes the physicians diagnostic acumen. When in doubt a burr hole must have to be made. A burr hole if performed by the initiated does not result in death. This discipline probably accounts for the comparatively low mortality in this series. The chances of life are approximately better than an 8 to 1 ratio if patients are operated on within the first 24 hours after injury. After the lapse of said period the prognosis will turn from bad to worseSeventh, fractures in the operable group seldom give any difficulty in diagnosis. The admitting house officer is again reminded to palpate the underlying skull if confronted with scalp lacerationEight, a foreign body inside the brain usually stirs one to immediately resort to surgical extraction. This is not superfluous as hematoma, edema and infection are common following this type of injury. (Summary)