A Secondary Head Injury results as a sequelae to the primary brain injury and includes:
A Intracranial Hematomas:
The intracranial hematomas are divided into:
1 EPIDURAL HEMATOMA:
Caused by a tear in the middle meningeal artery with blood clot collected between the dura and the overlying bone. In about 60 or 70% of cases there is an associated skull fracture. Usually the clot is located in the temporal area. Occasionally it is in the frontal, parietal or posterior fossa region. As it is an arterial bleed, the clot can get to a significant size within a short period of time with rapid rise in the intracranial pressure. If untreated there is a high rate of morbidity and mortality but effective and early treatment can result in complete recovery. In these cases there is no diffuse brain injury and the injury is localized to the area where the fracture and the hematoma is located. The aim of the management is to evacuate the clot as soon as possible and control the bleeding meningeal vessel.
In most cases this is an acute condition, however occasionally the bleeding is a result of venous tear and the blood clot develops slowly. This is particularly the case in the frontal and occipital regions. The clot is evacuated through a craniotomy but in acute situations where there are no facilities for major neurosurgical procedure a burr hole should be done to release the intracranial clot and reduce the intracranial pressure.
2. SUBDURAL HEMATOMA:
This is the result of tear in one of the bridging veins between the surface of the cortex and the dural sinuses. The blood collects gradually and slowly as the bleed is of venous origin. Acute subdural haematomas are rare in children. These haematomas are usually a part of severe and diffuse brain injury. It results with significant morbidity and mortality because of associated diffuse brain injury.
3. Brain Edema; 4. Infection 5. Hydrocephalus; 6. Leakage of CSF