SPORTS MEDICINE

Head Injuries

Daily Objectives

Content Objectives Learn the anatomy of the cranium and brain. Gain an understanding of the dangers

involved with head injuries. Language Objectives

Copy notes off of power point. Complete reading assignment.

Pace Lap

Why are head injuries so dangerous? 4 minutes

Head Injury Facts

Any injury to the scalp, cranium, or brain.

Can occur in any sport.Caused by the application of a sudden force.

Assignment

Please read page 531 and 532 label the cranium diagram and answer the following question. What two anatomical groups can we divide the head

into?1. Face

1. Eyes2. Ears3. Nose4. Jaw5. Mouth

2. Cranium1. Brain2. Spinal Cord

Anatomy of the Skull

Oblong, egg shaped collection of bones that is designed to protect the brain.

The Skull (Cranium)

Frontal Bone Anterior bone that

makes up the forehead. Very Strong

Temporal Bone Bone that makes up

the sides of the skull along the temples. Much weaker and more susceptible to fracture.

The Skull (Cranium)

Occipital Bone The most posterior

bone of the skull. Foramen Magnum: A

big hole in the occipital bone that allows the spinal cord to pass through.

http://faculty.washington.edu/chudler/skull.html

The Skull (Cranium)

Parietal Bone The largest of

the bones of the skull.

Protects the largest part of the brain.

Reading Assignment

Read pages 561- 562 and answer the following questions.1. What are the three parts of the

brain?2. Define the three parts of the

brain.3. What are the three meninges?4. Define the three meninges.

The Brain

Three Parts Brainstem Cerebellum Cerebrum

http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

Brainstem

Brainstem Lowest part of the brain that merges with

the spinal cord. Functions controlled in the brainstem

include: Breathing Heart Rate Blood Pressure Arousal (Awake and Alert) Digestion

http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

Cerebellum

Cerebellum Part of the brain that controls muscular

coordination and complex movements. Also known as:

Athletic BrainLittle Brain

http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

Cerebrum

Cerebrum The largest and most highly evolved part of

the brain. Divided into a right and left hemisphere. Divided into four different lobes.

Frontal Lobe Temporal Lobe Parietal Lobe Occipital Lobe

http://health.allrefer.com/pictures-images/lobes-of-the-brain.html

Lobes of the Cerebrum

Frontal Lobe Speech Higher Intellectual Functioning

Temporal Lobe Hearing Memory Speech Perception

Lobes of the Cerebrum

Parietal Lobe Somatic Sensory

Occipital Lobe Auditory Vision Visual Perception

Meninges

Protective membranes that surround the brain and spinal cord.

Dura Mater The outermost membrane that lies just beneath the skull

and covers the brain and spinal cord. Arachnoid

The membrane that lies beneath the dura mater. It is web like and covers the entire brain and spinal cord.

Subarachnoid space: Space between the arachnoid and the pia mater.

Pia Mater The innermost membrane that directly covers the spinal

cord and brain.

The Meninges

Pace Lap

What are the four lobes of the brain? 4 minutes

Background Info

½ of the trauma related deaths in the US are due to head injuries.

The mortality rate after a sever head injury is approximately 35%.

Three categories of Head Injuries1. Scalp Injuries2. Skull Fractures3. Brain Injuries

Scalp Injuries

Contusions and Lacerations are most common.

Key Question Does a scalp injury indicate an injury to

the skull or brain? No, they may or may not involve skull and

brain injuries. You can have an observable scalp injury

and no brain injury You may not have an observable scalp

injury, but have a severe brain and skull injury.

Signs and Symptoms of a Scalp Injury

Profuse bleeding. Swelling Tenderness Hematoma

(Goose Egg)

Treatment and Rehabilitation for Scalp Injuries

Locate and control bleeding with direct pressure.

The neurologist or physician should decide when the athlete should return to play.

Apply ice if there is no bleeding.

Refer to the nearest emergency facility when necessary.

Reading Assignment

Read the section titled “Skull Fractures” on page 564 and answer the following questions. What are some causes of a skull fracture? What are some signs and symptoms of a

skull fracture? What is the best treatment for a skull

fracture? Who may decide when the athlete can

return to play?

Skull Fracture

Not common in athletics Can be a simple fracture. Can be a compound/depressed fracture

These are more dangerous because the skull fragments can lacerate brain tissue.

Causes Direct blow to an unprotected head.

Skull Fractures

Signs and Symptoms Bleeding or Cerebrospinal fluid (CSF) that drains

from the ear or nose. Obvious deformity. Point tender upon palpation.

Treatment and Rehabilitation Immobilization and EMS. Treat for shock. Control Bleeding Return to play dictated by physician. Added protection when returning to play.

Pace Lap

Is the inside of the skull smooth or rough? How does this answer effect the brain? 4 minutes

Reading Assignment

Read page 564-565 regarding brain injuries and answer the following questions:1. What is the difference between a cerebral

concussion and a cerebral contusion?2. What is a contrecoup injury?3. What determines the severity of the brain

injury?4. True or False: A brain injury is a result of a

single blow to the head.

Brain Injuries

Usually result from movement of the brain within the skull.

Remember The inside of the skull is not smooth.

Two Types of Brain Injuries Concussion Contusions

BOTH are very serious injuries

Mechanisms Brain Injuries1. Direct Blow or Repetitive Direct Blows

1. Coupe Injury: When a moving object strikes the stationary head, and the injury is at the site of impact.

2. Contrecoupe Injury: When a moving head strikes a stationary object, and brain rebounds off of the opposite side of the skull and causes an injury at the opposite side of impact.

2. Sudden Acceleration or Deceleration of head

Impact occurs away from the head, but the energy is transferred.

3. Combination of both

Coupe vs. Countrecoupe Injury

Coupe Injury

Reading Assignment

Background Information

The brain can move in all directions and impact the inside of the skull.

Helmet to helmet football hits can occur in excess of 20 miles per hour.

Changes in brain velocity can reach up to 20 miles per hour during the game of football.

Signs and SymptomsCognitive Pathological Behavioral

Disorientation Headache Irritability

Loss of Focus and difficulty concentrating

Loss of consciousness Abrupt changes in mood.

Immediate Memory Deficits

Nausea/Vomiting Changes in personality

Delayed Memory Deficits

Vision difficulties (Poor Depth Perception)Loss of Vision

Fatigue

Dizziness Sleep Disturbances

Ringing in Ears Uncharacteristic Behaviors(TEE)

Neck Pain

Concussion Grading Criteria

Grade Classification

Symptoms

Grade I (Mild) No Loss of ConsciousnessTransient ConfusionPost Traumatic Amnesia and post concussion signs and symptoms that last less than 15 minutes.

Grade II (Moderate)

No Loss of Consciousness Transient ConfusionPost Traumatic Amnesia and post concussion signs and symptoms that last more than 15 minutes

Grade III (Severe) Any Loss of ConsciousnessBrief (seconds)Prolonged (minutes)

American Academy of Neurology

Returning The Athlete To PlayGrade Criteria for Return to Play

Grade I •Must be symptom free within 15 minutes of the initial injury. •Must be able to physically exert themselves without symptoms returning.•Must be cleared by a licensed physician

Grade II •May return to play when they are symptoms free for 1 week.•Athlete must be able to physically exert themselves without symptoms returning.•Must be cleared by a physician.

Grade III Brief LOC•Same as Grade IIProlonged LOC•May return to play when they are symptom free for 2 weeks.•Must be able to physically exert themselves without symptoms returning.•Must be cleared by a licensed physician

The Problem

1. Concussions are a “invisible” injury.

2. Proper diagnosis depends on the athlete to report “ALL” symptoms.

3. Athletes are not sure what they are feeling when the have a concussion.

Reading Assignment

Read the last page of the handout that was given to you on Friday.1. What conclusion can you make

about the reporting rates of concussions?

Reporting Rates• High School Athletic Trainers

• 4% - 8% of players reported having a concussion.

• High School Athletes• 15% – 70% reported having a concussion.

• The Bottom Line• Athletes do not report symptoms.

• Why?▫ They Do Not Want To Leave The Game▫ Afraid of Letting Down Coaches and Teammates.▫ They are not sure what they are feeling.▫ “Are you hurt or are you injured”?

Dangers of a Second Impact

Second Impact Syndrome Occurs when an athlete sustains a direct or

indirect force to the head before recovering from the last concussion.

Dangers Increase in severity of symptoms. Increase in the amount of time that

symptoms hang around. Post Concussion Syndrome

DEATH Occurs in 50% of the cases

Pace Lap

What is second impact syndrome? 4 minutes

Second Impact Syndrome

Second Impact Syndrome Occurs when an athlete sustains a direct or

indirect force to the head before recovering from the last concussion.

Dangers Increase in severity of symptoms. Increase in the amount of time that

symptoms hang around. Post Concussion Syndrome

DEATH Occurs in 50% of the cases

Reading Assignment

Please read page 574 and 575 and answer the following questions:1. What are five signs and symptoms of a

brain contusion?2. Which are objective and which are

subjective?3. What is aphasia?4. What can cause a hemorrhage?5. List and define the three types of

hematomas that can occur within the skull?

Brain Contusions

AKA: Bruising of the Brain Cause

When the brain collides with any part of the skull. Effects

Decreased nerve function. Depending on the portion of the brain that is bruised.

Signs and Symptoms Numbness Weakness Loss of Memory Aphasia: Loss of speech or comprehension. General Misbehavior

Brain Hemorrhage

Hemorrhage = Bleeding LIFE THREATENING CONDITION Causes

Direct or indirect blow to the head. Contact between the brain and inside of the

skull can damage or lacerated blood vessels.

The hemorrhaging can cause a hematoma. A pooling of blood within the tissues.

Intracranial Hematomas

Subdural Hematoma Hematoma that develops between the

brain and the dura mater. Epidural Hematoma

Hematoma that develops between the skull and the dura mater.

Intracranial Hematoma Hematoma that develops within the brain.

Subdural Hematoma

The most frequent cause of death due to trauma in athletics.

Tearing of the cerebral vessels between the brain and dura mater. Usually occurs as a result of a twisting

motion of the hemispheres. Bleeding may occur rapidly or slowly.

Symptoms may be present immediately or may not appear for hours or days after.

Epidural Hematoma

Injury to the arteries between the skull and the dura mater. Usually associated with a skull fracture.

Bleeding occurs between the skull and the dura mater.

Hematoma occurs rapidly and signs and symptoms develop rapidly.

Intracranial Hematoma

Occurs when blood vessels within the brain are disrupted.

Associated with cerebral contusions.

Signs and Symptoms of Hemorrhages

Hematoma places pressure on the hemispheres of the cerebrum and causes a decreased Neurological Function. Altered levels of consciousness. Slowed pupil reactions Loss of movement Loss of speech. Etc……

Constant Re-evaluation is important.