Central Nervous System Trauma

Estrada Bernard, MD

Division of Neurosurgery

UNC Chapel

U.S fatalities >150,000/yr SCI >10,000/yr Disabled (prev) >200,000

Central Nervous System Trauma –Incidence (San Diego)

Head Inj

Mod/Sever

Spinal

1978 295 40

1981 180 44

1992 150 33 4.2

1997 144 34 4

Assume spinal injury Maintain alignment Watch for spinal shock

Head Injury

Primary Secondary

Secondary Head Injury

Elevated ICP Hypotension Hypoxemia/Hypercapnia Ischemia Seizures

Central Nervous System Trauma – Acute Evaluation

Primary survey (ABC) Initial neurological exam Post resuscitation exam

Central Nervous System Trauma – Airway Mgmt

Avoid hypoxia Avoid hypercarbia Avoid aspiration

Central Nervous System Trauma - Resuscitation

Goals BP > 90 mm Hg PaO2 > 60 mm Hg

Central Nervous System Trauma – Acute Mgmt

??? Sedation ??? Neuromuscular blockade ??? Mannitol ??? Hyperventilation

Cranial Nerve Injury

Olfactory

Abducens

Facial

Vestibulocochlear

Central Nervous System Trauma - Pathophysiology

Mediators Mechanical Neuroexcitation Free radical production

Skull Fractures

Types Risk factors

Skull Fractures

Linear 62% of severe HI

Depressed Simple Compound

Basilar csf fistula

Head Injury Mechanisms

Contact Skull deformation

Local - skull fx, EDH, coup Remote - vault, basilar fxs

Shock wave Contrecoup ICH

Head Injury Mechanisms

Acceleration Surface strain

SDH Contrecoup

Deep strain Concussion Dai

Focal Injury

Hematoma Extradural Subdural Intracerebral

Contusions Coup Contrecoup

Diffuse Injury

Concussion Diffuse axonal injury

Mild Moderate Severe

Central Nervous System Trauma – Clinical Trials

Cholinergic agents Corticosteroids Barbiturates Neuroexcitatory antagonists Free radical scavengers Calcium channel antagonists Hypothermia

Central Nervous System Trauma – Elevated ICP Rx

Progressive neurologic deterioration Transtentorial herniation

Steroids for Spinal Cord Injury

8 hour therapeutic window Methylprednisolone 30 mg/kg bolus 5.4 mg/kg/hr infusion over 23 hours

Cervical Spine Injuries

Atlanto-occipital dislocation Odontoid fractures Hangman’s fracture Jefferson’s fracture

Burst fractures Hyperflexion-anterior subluxation Facet dislocations Hyperextension injuries

Cervical Spine Injuries

Prevention is better than cure

Central Nervous System Trauma

Documents

Central Nervous System (CNS) –Central Nervous System (CNS) – –Brain and spinal cord Peripheral Nervous System (PNS) –Peripheral Nervous System (PNS) –

V. CENTRAL NERVOUS SYSTEM TRAUMAmsg2018.weebly.com/uploads/1/6/1/0/16101502/cns_trauma.pdf · V. CENTRAL NERVOUS SYSTEM TRAUMA. I. Concussion - Is a clinical syndrome of altered consiousness

Central nervous system infections Central nervous system infections

Head and Spinal Trauma RIFLES LIFESAVERS. Central Nervous System The brain and spinal cord comprise the central nervous system (CNS) The brain and spinal

Nervous System Introduction and Central Nervous System

Your Nervous System Central Nervous System. Engage

Head Trauma. Anatomy of Nervous System The nervous system is composed of Brain Spinal cord The nervous system is divided into: Central nervous

CENTRAL NERVOUS SYSTEM TRAUMA - … · CENTRAL NERVOUS SYSTEM TRAUMA •Trauma to the brain and spinal cord is a significant cause of death and disability. •Penetrating •Blunt

Central nervous-system

Central Nervous System, The Autonomic Nervous System

Integration Central nervous system Peripheral nervous

Nervous System Central Nervous System (CNS) Peripheral Nervous System (PNS)

Objectives - Nervous System - KDMassey.orgkdmassey.org/student/Medical Terminology/Nervous System.pdf · Central Nervous System Brain: major portion of the central nervous system

The Nervous System YILUN LI. The Nervous System Divided into two parts: ◦Central nervous system ◦Peripheral nervous system The central nervous system

The Central Nervous System Upload 9.10 Central Nervous System Notes 1

Organs of the nervous system are divided into Central Nervous System (CNS) Central Nervous System (CNS) Peripheral Nervous System (PNS) Peripheral Nervous

The NERVOUS SYSTEM Central & Peripheral Nervous System

Chapter 8 The Nervous System. Organization of nervous system Central Nervous System Central Nervous System Peripheral Nervous System Peripheral Nervous

The Nervous System. The Central Nervous System The Central Nervous System processes all of the body’s information. The two parts of the central nervous

Central Nervous System.ppt