Scribd Logo
Upload

Welcome to Scribd!

  • 60 views

    Neurosurgical Emergencies

    Uploaded by

    Farah Wahidah Abd Razak
    The document provides an overview of neurosurgical emergencies focusing on head injury and anatomy related to the scalp, skull, meninges, and brain. It describes the layers of the scalp and how injury can cause profuse bleeding. It outlines the bones that make up the skull and identifies vulnerable areas like the pterion. The circulation of cerebrospinal fluid and its function protecting the brain are summarized. Mechanisms of head injury including distortion, deceleration, and acceleration are explained. The pathology of primary brain injury caused by impact and secondary injury from processes like swelling and hemorrhage are reviewed. Key anatomical structures are depicted in various views of the skull.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Neurosurgical Emergencies

    Uploaded by

    Farah Wahidah Abd Razak
    60 views25 pages
    The document provides an overview of neurosurgical emergencies focusing on head injury and anatomy related to the scalp, skull, meninges, and brain. It describes the layers of the scalp and how injury can cause profuse bleeding. It outlines the bones that make up the skull and identifies vulnerable areas like the pterion. The circulation of cerebrospinal fluid and its function protecting the brain are summarized. Mechanisms of head injury including distortion, deceleration, and acceleration are explained. The pathology of primary brain injury caused by impact and secondary injury from processes like swelling and hemorrhage are reviewed. Key anatomical structures are depicted in various views of the skull.

    Original Description:

    USE WELL

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides an overview of neurosurgical emergencies focusing on head injury and anatomy related to the scalp, skull, meninges, and brain. It describes the layers of the scalp and how injury can cause profuse bleeding. It outlines the bones that make up the skull and identifies vulnerable areas like the pterion. The circulation of cerebrospinal fluid and its function protecting the brain are summarized. Mechanisms of head injury including distortion, deceleration, and acceleration are explained. The pathology of primary brain injury caused by impact and secondary injury from processes like swelling and hemorrhage are reviewed. Key anatomical structures are depicted in various views of the skull.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    60 views25 pages

    Neurosurgical Emergencies

    Uploaded by

    Farah Wahidah Abd Razak
    The document provides an overview of neurosurgical emergencies focusing on head injury and anatomy related to the scalp, skull, meninges, and brain. It describes the layers of the scalp and how injury can cause profuse bleeding. It outlines the bones that make up the skull and identifies vulnerable areas like the pterion. The circulation of cerebrospinal fluid and its function protecting the brain are summarized. Mechanisms of head injury including distortion, deceleration, and acceleration are explained. The pathology of primary brain injury caused by impact and secondary injury from processes like swelling and hemorrhage are reviewed. Key anatomical structures are depicted in various views of the skull.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    NEUROSURGICAL

    EMERGENCIES
    part 1
    NURUL FARAH WAHIDAH ABD RAZAK
    118129

    ANATOMY OF SCALP
    Skin
    firmly bound to the 3rd layer by perpendicular
    fibers
    Connective tissue (Dense)
    Contain arteries, veins & nerves supplying
    scalp
    cut/injury >> profuse bleeding
    Aponeurosis
    fibrous sheet, found over much of the vertex
    attaches occipitalis to frontalis muscle
    Loose connective tissue
    Separates aponeurosis to pericranium
    accounts for the mobility of the scalp >>due to
    its consistency >>blood tracks freely in this
    layer bilateral orbital edema following
    severe head injury or cranial operation &
    infection tend to localize and spread
    Periosteum/pericranium
    adheres to the suture lines of the skull
    collection of blood beneath this layer
    cephalohematoma (children)

    ANATOMY OF THE SKULL


    skull has 22 bones excluding the ear
    ossicles

    The

    Bones

    of the skull are attached to each other


    by sutures, are immobile and form the cranium

    Cranium

    subdivided into:

    Upper

    doomed part (calvaria) which covers the


    cranial cavity

    Base

    that consist of floor of cranial cavity

    Lower

    anterior part facial skeleton

    Skull Anterior view


    The

    anterior view of
    the skull includes the
    forehead superiorly,
    inferiorly the orbits,
    the nasal region, the
    upper jaw and the
    lower jaw

    Skull Lateral view

    Bones forming the lateral


    portion of the skull
    include the frontal,
    parietal, occipital,
    sphenoid, and temporal
    bones

    Bones forming the visible


    part of the facial skeleton
    includes the nasal,
    maxilla, and zygomatic
    bones

    The mandible forms the

    PTERIO
    N

    Pterion
    Fusion of cranial bones (frontal ,
    temporal , parietal , sphenoid)
    Skull # in this area can be very serious
    Thin & overlies the ant division of middle
    meningeal artery

    Middle meningeal artery


    (ant. division)
    *Weakest point of the skull
    Complication
    Epidural/extradural haematoma

    Skull Superior view

    Bregma

    Anterior to posterior direction :


    - the unpaired frontal bone
    articulates with the paired
    parietal bones at the coronal
    suture
    - the two parietal bones
    articulate with each other in
    the midline at the sagittal
    suture
    - the parietal bones articulate
    with the unpaired occipital
    bone at the lambdoid suture

    Lambda

    Skull Inferior view

    The base of skull is often


    divided into :
    - anterior part, which includes
    the teeth and the hard palate
    - middle part which extends
    from behind the hard palate to
    the anterior margin of the
    foramen magnum
    - posterior part which extends
    from the anterior edge of the
    foramen magnum to the
    superior nuchal lines

    Skull Posterior view


    Occipital,

    parietal and
    temporal are seen

    Several

    body
    landmarks;
    External

    occipital
    protuberance

    Sup
    Inf

    nunchal lines

    nunchal lines

    External

    occipital crest

    Cranial cavity - Roof


    Dome-shaped

    roof that
    protects the superior
    aspect of the brain.

    It

    consists mainly of the


    frontal bone anteriorly,
    the paired parietal bones
    in the middle, and the
    occipital bone posteriorly

    Markings

    on internal
    surface include body
    ridges, grooves and pits

    Cranial cavity - Floor


    The

    floor of the
    cranial cavity is
    divided into
    anterior, middle
    and posterior
    cranial fossae

    Fracture of anterior cranial fossa bleeding and discharge of CSF through the nose
    (rhinorrhoea)
    May also cause a condition called black/racoon eye ( seepage of blood into the
    eyelid )

    Halo sign

    Fracture of middle cranial


    fossa discharge of CSF
    through the ear
    Involve sphenoid bone
    bleeding through the nose
    or mouth

    Meninges
    Dura
    Outer periosteal attached to skull, contain
    meninges arteries
    Inner meningeal close contact with
    arachnoid, continuous with spinal dura
    Dural partitions subdivided cranial cavity,
    they include falx cerebri & cerebelli,
    tentorium, diaphragm sellae
    Form intracranial venous structures
    Arachnoid
    Thin, avascular membrane
    Line inner surface of dura
    arachnoid granulations
    Pia
    Thin, delicate membrane, firmly attached to
    surface of the brain
    highly vascular
    dips into sulci and fissures
    carries cortical vessels

    Complications:
    -Meningeal laceration / tear
    -Herniation

    Arrangements of
    meninges and spaces

    Extradural space (dura bone)


    potential space

    Become fluid filled space in a traumatic


    event

    Bleeding into extradural space due to


    rupture of meningeal artery or dural
    venous sinus

    Subarachnoid space deep to


    arachnoid

    Actual normally occurring fluid filled space

    Contain csf & blood vessels

    SAH occur in patient having significant


    cerebral trauma or ruptured intracerebral
    aneurysm arise from vessels supplying
    and around circle of wilis

    Subdural space (duraarachnoid)

    Hematoma results from venous bleeding


    usually from torn cerebral vein

    Blood Supply
    Brain

    receive arterial
    blood supply from 2
    pairs of vessels:
    Vetebral
    Internal
    These

    arteries
    carotid arteries

    2 pairs of vessels
    interconnected in
    cranial cavity forming
    circle of wilis which give
    rise to all major cerebral
    arteries

    Venous Drainage
    Begin

    as networks of
    small venous channels
    lead to larger cerebral
    vein, cerebellar vein
    and vein draining the
    brainstem

    Eventually

    drain into
    dural venous sinuses

    Eventually

    drain into
    internal jugular vein

    CSF
    a

    clear, colorless liquid that bathes the brain


    and spinal cord.

    contained

    in the ventricular system of the


    brain and in the subarachnoid space around
    the brain and spinal cord

    Formation:
    Bulk

    formed by choroid plexus of the lateral


    ventricle (50%)

    Lesser

    choroid plexus of the 3rd and 4th


    ventricle(40%)

    Possibly

    (10%)

    capillaries on the surface of brain and SC

    Quantity 130-150
    ml
    Formed rate of 200
    ml per hour / 5000
    ml per day
    Normal pressure
    60 to 100 mm of CSF

    CSF CIRCULATION

    CSF FUNCTION
    Major

    fx cushion the brain within its solid vault

    Decreases

    the sudden pressure or forces on delicate


    nervous tissue

    Nourishes

    nervous tissue. Only CSF come in contact


    with neurons, not blood. It provide nourishment and
    returns products of metabolism to the venous sinuses

    Supply
    Pineal
    No

    glucose and oxygen to neurons

    gland secretions reach pituitary gland via CSF

    CSF brain barrier, so drugs can reach the neurons

    Introduction to head injury

    A head injury is any trauma that leads to injury of the scalp,


    skull, or brain

    A common injury and is a significant cause of morbidity and


    death.

    Epidemiology & Etiology


    Approx. 300/100000 of the population in UK requires hospital
    admission per year due to head injury
    9/100000 dies.
    Typically occurs in young male adults.
    Accounts for 10% of all deaths
    Principal causes: RTA, fall, assaults, work/home injury, sports
    RTA: young male and alcohol involved.
    May occur in isolation but often patient has multiple injuries
    Among patient with multiple injuries 50% dies from head injury

    Mechanism of head
    injury
    Distortion of the
    brain

    Brain is a soft structure, has a mobility and


    easily distort
    Impact to the brain shearing force in the
    brain damage the neuron, supporting tissue
    and blood vessels.
    Lead to : loss of consciousness, focal
    neurological deficits.
    Damages may be temporary or permanent

    Configuration of interior of
    skull
    Damage is less severe over the smooth area
    But severe over the rough and sharp area
    The damage is severe over the anterior cranial
    fossa, over the falx and over the tentorium

    Deceleration and acceleration


    injury
    Deceleration : occur when moving head
    strikes the immovable object ( RTA)
    Acceleration : occur when stationery skull
    is struck by moving object ( assault)

    Cerebral concussion, contusion, laceration


    Concussion : slight distortion cause
    temporary physiological changes
    Contusion : more severe degree of
    damage with bruising and cerebral
    oedema lead to diffuse or localized
    changes.
    Laceration : tearing of brain surface
    with collection of blood in different
    spaces and with displacement of dural
    parts.

    Pathology of head injury


    Primary lesion
    o Injury occurs at the moment of trauma
    o Include:

    Diffuse neuronal damage


    Cerebral concussion
    Cerebral contusion &

    laceration

    Secondary lesion
    o Injury occurs gradually
    o may involve an array of cellular

    processes, not caused by mechanical


    damage
    o can result from the primary injury/

    initiated by the trauma


    o Include:

    Brain swelling
    Edema
    Venous congestion
    hypoxia

    Intracranial hemorrhage
    Extradural/epidural hematoma
    Subdural hematoma

    Infections

    References
    GRAYS ANATOMY FOR STUDENT
    TEXTBOOK OF PHYSIOLOGY, VOL 1
    MANIPAL MANUAL OF SURGERY

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy