Primary head Injury

TBI complications by system

Bony/Dural/CSF	Vascular	Parenchymal
Air sinus injury	Traumatic SAH	Concussion
Mucocele	EDH	Hypotension/hypoperfusion injury
Osteomyelitis	ASDH CSDH	Hypopituitarism (Diabetes insipidus/ secondary adrenal insufficiency/GH Deficiency/hypothyroidism/Hypogonadism)
CSF fistula	Dissection	DAI
Hydrocephalus	Carotid-cavernous fistula	seizures
Meningitis	Traumatic aneurysm
Pneumocephalus
Subdural hygroma
Cranial nerve injury

ICH	• Focal lesion + ◦ Progressive neurological deterioration ◦ Medically refractory raised ICP ◦ A hematoma volume more than 50 cm3 (>50 ml) ◦ GCS score of 6 to 8 in a patient + Frontal or temporal haemorrhage more than 20 cm3 (>20 ml) + either midline shift of more than 5 mm / cisternal compression on CT scan • Refractory intracranial hypertension+ Diffuse injuries + radiographic evidence for transtentorial herniation
EDH	• > 30 cm3 regardless GCS (Brain trauma foundation-BTF) • Patients presenting with (progressive) focal neurologic signs or symptoms and/ or hematoma growth • GCS score < 9 + anisocoria
ASDH	• Regardless of the GCS with the following ◦ Thickness > 10mm on CT OR ◦ Midline shift > 5 mm on CT • GCS <9 + SDH < 10-mm thick + midline shift < 5mm ◦ Should undergo surgical evacuation of the lesion if ▪ GCS score decreased between the time of injury and hospital admission by 2 or more points on the GCS and/or ▪ The patient presents with asymmetric or fixed and dilated pupils and/or ▪ The ICP exceeds 20 mm Hg.