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 Eminent Neuro Surgeon Dr. Jolly George MS; M.Ch. comments on the management of Neuro Trauma
The Present responsibility of the Neurosurgeon is to avoid mortality and morbidity and if possible bring the head injured person back to his original status. In head injury for the best neurological out come, the definitive management should be done within 2 hours of head injury.
This first 2 hours of the head injury is called Golden hours of head injury. The general public has to be made aware of the importance of this Golden hours of head injury.
Management of head injury
Consists of initial resuscitation in the casualty, CT Scan examination and final definitive management depending up on the intracranial pathology as revealed by the CT Scan. Initial resuscitation consists of maintenance of Airway, Breathing and circulation(A,B,C) Assessment of level of consciousness is based on Glasgo Coma Score(GCS). |
| Total Score normal |
15/15 |
| Mild head injury |
12-15 |
| Moderate head injury |
9-12 |
| Severe head injury |
less than 8 |
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All patients with GCS less than 8 should be intubated and ventilated for atleast 24 hours.
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| Pathology and management of head injury. |
| Fracture Skull |
1 |
Closed Fracture : treatment is observation |
2 |
Depressed Fracture : Elevation (Surgical) |
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| Extradural haematoma |
Large with midline shift and mass effect - immediate surgical evacuation. Small EDH with no midline shift and mass effect - observation - only. In extradural haematoma, the brain is normal. The neurological deficit is due to the pressure of the brain by the EDH. So early evacuation gives very good prognosis. If there is delay, the accumulated haematoma will press on brain stem and affecting all vital centres leading to respiratory arrest and death. |
| Subdural haematoma |
Large haematoma with midline shift and mass effect, the treatment is early surgical evacuation. Small haematoma with minimal mass effect, may be treated conservatively. Subdural haematoma is usually associated with brain parenchymal injury, hence the prognosis is not as good as that of extra-dural haematoma. |
