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  Trauma

Iraq has become well known these days because of the daily violence explosions, assassinations and fighting have became usual events in Iraqi's life.

this page shows some of the head trauma cases as a result of the missile and bullet injuries as well as fighting and road traffic accidents.

 

 

 

     

 

Child 10 years old had accidental bullet injury follow by a  fall on ground, massive bleeding from occipital region. Brain CT scan show a bullet arrested at posterior cranial fossa. During surgery a bullet traction carefully after small incision above her cranial wound and muscle separations. Postoperatively the patient very well so discharge to home.

 

Brain CT scan show a bullet arrested at posterior cranial fossa

 

Brain CT scan (bone window) show a bullet arrested at posterior cranial fossa

 

30 years old female had fall on ground more than 5 meter height, follow by sudden loss of consciousness. Brain CT scan show large collection right parieto-occipital extradural hematoma with overlaying linear fracture extended to the base of skull. Surgery was done immediately to evacuate the extradural hematoma after craniotomy flap. Postoperatively the patient return awake without any neurological deficit.

 

 

Brain CT scan show large collection right parieto-occipital extradural hematoma

Brain CT scan show linear fracture extended to the base of skull

Brain CT scan show right parieto-occipital  linear fracture

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21 years old male exposed to cranial bullet injury perforating his skull from left side. Brain CT scan show sever depress fracture with a bullet arrested at left temporal lobe, which have centre of speech. Completely removed of a depress segment, evacuation of hematoma, extraction of the bullet with dural patching was done during surgery. After surgery he was talking and walking normally.

 

Brain CT scan show

 depress fracture with a bullet arrested at left temporal lobe

 

Brain CT scan (bone window) show a bullet arrested at left temporal lobe

 

 

19 years old male exposed to perforated cranial bullet injury  for his skull from left side and exit from right side with loss of his consciousness. Brain CT scan show a tract of hematoma extend from entrance to exit sit. Completely removal of a depress segment, evacuation of hematoma with dural patching was done during surgery. After surgery he was gradual improvement within ten days and return to his consciousness .

 

Brain CT scan

 a tract of hematoma extend from entrance to exit sit

 

Brain CT scan

 after two week show disappear of a tract of hematoma

 

 

 

33 years old male presented as a case of road traffic accident with completely loss of his consciousness. Brain CT scan show a depress segments at left frontal region with involving left orbit. Completely removal of a depress segment, reconstruction of the orbital margin with dural patching was done during surgery. After surgery he is gradual improvement and completely return his consciousness.

 

Brain CT scan

  fracture involving left orbit

 

Brain CT scan       

 a depress segments at left frontal region

 

 

25 years old male had cranial shell injury with completely loss of his consciousness. Brain CT scan show a depress segments seated at left temporal region with extensive intracerebral and intraventricular hemorrhage. Completely removal of a depress segment, evacuation of hematoma with dural patching was done during surgery. After surgery he is gradual improvement completely return to consciousness.

 

 

 

 

 

 

 

 

 

 

 

 

Brain CT scan

 a depress segments with  intracerebral hemorrhage

 at left temporal region

Brain CT scan at 7 postoperative day show disappears of

  depress segments, intracerebral, intraventricular hemorrhage

 

 

 

 

Brain CT scan

  extensive  intraventricular hemorrhage

 at left temporal region

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

63 years old male had a headache, inability to walking and lastly loss of consciousness for one weak. He has history of mild head trauma before one month. Brain MRI show a big left sided subdural hematoma. A burr hole was done for evacuation of hematoma. Immediately after surgery the patient return oriented and he became able to walk.

 

 

Brain MRI show

 a big left sided subdural hematoma

 

Brain MRI show 

a big left sided subdural hematoma

 

Child 10 years old had Head trauma with large screw driver  penetrating his skull. Brain CT scan revealed the screw driver penetrated about one inch inside his brain. Urgent surgical intervention was done to remove the screw driver carefully under general anesthesia with repair of the brain damage. In the first postoperative day, he was very well with no serious complications.

 

 

 

skull x-ray

 

 

 

 

Brain CT scan  screw driver penetrated   brain

 

30 years old male exposed to road traffic accident.  He had breathing difficulty  with loss of the ability to move   both legs. Urgent chest tube inserted to evacuate blood collection inside the chest . Dorsolumbar MRI showed severe fracture at D8-D9 with spinal cord compression. Internal vertebral column fixation with spinal cord decompression  was done.

 

 

 

 

dorsal x-ray  showed  fracture at D8-D9

MRI showed  fracture at D8-D9

 

 

 

49 years old male had multiple intracranial shell injury. He was  confused  with impairment of vision. Brain CT scan showed two inlet at left occipital area, one of them impacted in the bone and the other perforated and arrested at the right parietal lobe. Immediate surgery was done:

1-Removal of left shell.

2-Craniectomy at left occipital bone with dural patch (site of shell entrance).

3-Craniotomy to the right parietal bone for evacuation of intracerebral hematoma.

After 3 days, he got good improvement in his vision.

 

 

 

Brain CT scan  1st entrance site

 

Brain CT scan 2nd entrance site

 

30 years old male had motor cycle accident, presented to emergency unit with coma and bleeding from the right ear. Brain CT scan showed large right temporal extradural hematoma compressing the brain temporal side. Urgent craniotomy was done with evacuation of brain hematoma. He  improved and discharged home in a full consciousness in the 8th postoperative day.

 

 

 

Brain CT scan right temporal extradural hematoma

Right temporal extradural hematoma

 

 

Child 5 years old presented with sudden fall on the ground when he was playing outside his home. His family thought that someone hit  their child. On examination he was unconscious with small wound on his vertex, left dilated pupil (very dangerous sign of brain injury). Brain CT scan showed bullet arrested at left temporal lobe with tract hematoma from vertex.

Left sub temporal craniectomy was done, extraction of bullet and evacuation of hematoma. In the 1st postoperative day, he became conscious but still unable to talk and weakness in the right side. In the 2nd  postoperative day ,he started  talking with gradual increase in the power of right side. After one month, he was completely returned back to normal activity  with freely talking  and walking.

 

 

Brain CT scan site of entrance

 

Brain CT scan bullet arrested at left temporal

Child 7 years old had a mild road traffic accident. No loss of consciousness ,no vomiting. Brain CT scan showed normal. In the next day, the patient was very well, eating and walking normally. Repeated brain CT scan showed same results. After 2 days he started to have headache,  repeated vomiting with attacks of generalized fit, not responding to antiepileptic therapy. On examination, the patient was very risky,  he was unconscious with right dilated pupil (very dangerous sign of brain herniation). Brain CT scan showed very big right intracerebral hematoma with intraventricular haemorrhage. Immediate surgical intervention, right frontal craniotomy with evacuation of  intracerebral hematoma, homeostasis, external ventricular drain to evacuate intraventricular blood. At 2nd postoperative day ,the right pupil retained to normal size but still  had inability to move eye ball( oculomotor palsy). The external ventricular drain became clear and it was removed.  The patient kept under courses of aggressive physiotherapy.  He was gradually  improved. After one month seemed very well with an ability to talk and walk. 

 

 

Brain CT scan 28-10-06

 

Brain CT scan intracerebral haemorrhage

 

Brain CT scan

29-10-06

 

Brain CT scan disappear  intracerebral haemorrhage

17 years old male had Intracranial shell injury, inlet site from right occipital area and arrested at left thalamus causes tract hematoma with intraventricular  haemorrhage. on arrival to the  causality he was  unconscious with  pinpoint pupils and left side weakness .

 

Operated on for evacuation of intracerebral hematoma, removal of bone pieces with external ventricular drain. He was improved  postoperatively.

 

 5th day, the Patient developed repeated vomiting   because of blocking of the external shunt with clot.  and shunt revision was done.

 

9th day started to develop complications, he was feverish with neck stiffness and loss of consciousness. Removal of the external drain and cover with powerful antibiotics. The patient gradually  improved and he became conscious .on the 33rd day he discharged home .

 

After one year he was speech difficulty and spastic limbs. Brain CT scan showed hydrocephaly with periventicular oedema. frontal ventriculoperitoneal shunt was done. In the postoperative day, he was able to  speak frankly with normal gait.

 

 

Brain CT scan sequences

 

Shell entrance site

 

 

Shell arrested site

 

 

ventricular drain disappear intraventricular haemorrhage

 

after 3 month Brain CT scan show diluted ventricules

 

 

Intraventricular hemorrhage

 

Postop. remove of depress seg. with ventricular drain

 

Removable ventricular drain

 

 

 

frontal ventriculo-peritoneal shunt

 

 

 

 

 

 

42 years old male had a depressed occipital fracture with injury to the posterior third of the superior sagital sinus. He was presented to causality as severe bleeding from the wound with blindness.  During surgery severe multiple, depressed segments was found causing partial tear to   posterior third of the superior sagital sinus. He received 5 pints of blood within 30 min, removal of bony pieces, dural suturing was done.  In the 4th  postoperative day ,his vision improved ,so he discharged  home. 

 

Brain CT scan fracture site

Brain CT scan bone window

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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