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.
2.
3.
4.
5.
2.
Eyes
Ears
Nose
Jaw
Mouth
Cranium
1.
2.
Brain
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.htm
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 Brain
 Little 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


Arachnoid



The outermost membrane that lies just beneath the skull and
covers the brain and spinal cord.
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 Injuries
1.
2.
3.
Scalp Injuries
Skull Fractures
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 Injuries
Direct Blow or Repetitive Direct Blows
1.
1.
2.
2.
3.
Coupe Injury: When a moving object strikes the
stationary head, and the injury is at the site of impact.
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.
Sudden Acceleration or Deceleration of head
 Impact occurs away from the head, but the
energy is transferred.
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 Symptoms
Cognitive
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 Consciousness
Transient Confusion
Post Traumatic Amnesia and post concussion signs and symptoms that
last less than 15 minutes.
Grade II (Moderate)
No Loss of Consciousness
Transient Confusion
Post Traumatic Amnesia and post concussion signs and symptoms that
last more than 15 minutes
Grade III (Severe)
Any Loss of Consciousness
Brief (seconds)
Prolonged (minutes)
American Academy of Neurology
Returning The Athlete To Play
Grade
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 II
Prolonged 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.
2.
3.
Concussions are a “invisible” injury.
Proper diagnosis depends on the athlete
to report “ALL” symptoms.
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
•
•
High School Athletes
•
•
15% – 70% reported having a concussion.
The Bottom Line
•
•
4% - 8% of players reported having a concussion.
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.
2.
3.
4.
5.
What are five signs and symptoms of a brain
contusion?
Which are objective and which are subjective?
What is aphasia?
What can cause a hemorrhage?
List and define the three types of hematomas that can
occur within the skull?
Brain Contusions


AKA: Bruising of the Brain
Cause


Effects



When the brain collides with any part of the skull.
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.