Head Injury:

Classification of a head injury is based on 3 factors:

Mechanism

• Closed head injury i.e. falls, automobile accidents (low & high velocity), assaults
• Penetrating head injury i.e. gunshot, stabbing & other open injuries

-there are areas of overlap

Severity

-the GCS (Glasgow Coma Scale) developed in 1974 by Teasdale and Jennett is the international standard by which head injuries are scored. It gives an indication of outcome and ranges from 3-15.

-Teasdale and Jennett defined coma as the inability to follow commands, utter words and to open the eyes. All three criteria need to be met.

• Mild head injury: GCS 14-15
• Moderate head injury: GCS 9-13
• Severe head injury: GCS 8 or lower (patient is considered comatose)

Morphology

-in this classification there is a division of the skull and intracranial contents:

A. Skull fracture

• vault

1. linear/stellate
2. depressed/non-depressed

• basilar

1. with or without CSF leak
2. with or without VII nerve palsy

B. Intracranial lesions

• focal

1. epidural
2. subdural
3. intracerebral

• diffuse

1. mild concussion
2. classic concussion
3. diffuse axonal injury