NEUROSURGERY LECTURES
Prof. Dr. Ali Al-Shalchy
M.B.CH.B F.IC.S M.R.C.S F.R.C.S
HEAD INJURY
CLASSIFICATION OF HEAD
INJURY (H.I.)
1- Blunt injury
A-Acceleration injury 
B-Decceleration injury 
C-Acceleration-Decceleration injury 
D-Rotational injury
2-Penetrating injury
SIGNS OF A H.I.
CLOSED H.I.
MECHANISMS OF CLOSED
H.I.
OPEN H.I.
DAMAGE CAUSED BY H.I.
1-Primary
2-Secondary
A-Infection 
B-Brain oedema 
C-Intracranial hemmorhage
(I.C.H.)

BRAIN INFECTION (ABSCESS)
NORMAL & OEDAMATOUS BRAIN
I.C.H.
MANAGEMENT Of H.I.
Investigations 
1-Skull X-ray 
2-CT-Scan 
3-MRI 
4-Angiography, EEG 
CT-SCAN MACHINE
MRI MACHINE
MANAGEMENT OF NON
COMPLICATED H.I.
-Indications for admission of a 
patient with H.I. : 
1.loss of consciousness 
2.skull fracture(s) 
3.neurological deficit 
4.medical diseases 
5.convulsion following head injury 
6.persistant headache and vomiting 
7.doubtful cases 
Line of management runs in
three lines
1-Observation
A-Level of consciousness
B-Pupil
C-Vital signs
D-CNS signs (focal signs)
Level of consciousness
Glascow coma scale
Glasgow Coma Scale
ASSESSMENT AREA
Eye Opening (E)
- Spontaneous
- To speech
- To pain
- None
BEST Motor Response (M)
- Obeys commands
- Localizes pain
- Normal flexion (withdrawal)
- Abnormal flexion (decorticate)
- Extension (decerebrate)
- None (flaccid)
Verbal Response (V)
- Oriented
- Confused conversation
- Inappropriate words
- Incomprehensible sounds
- None
SCORE
4
3
2
1
6
5
4
3
2
1
5
4
3
2
1
COMMENT
Best possible score
is 15, worst possible
is 3.
MANAGEMENT ACCORDING TO
SEVERITY
UNEQUAL SIZED PUPILS
2-Nursing care 
A-Airway 
B-Management of restless patient 
C-Sphinctor care 
D-Skin care 
E-Feeding 
F-Antibiotics 
AIRWAY PIECES
ENDOTRACHEAL TUBE
ENDOTRACHEAL INTUBATION
INTUBATED SEVERELY H.I.
PATIENT
TRACHEOSTOMY
TRACHEOSTOMY TUBE CARE
MECHANICAL VENTILATION
BED SORES (PRESSURE ULCERS)
TYPES OF NUTRITION
NG-TUBE
NG-TUBE
GASTROSTOMY TUBE
3-Indications for surgery
A-Simple stiching 
B-Open H.I. (Penetrating) 
C-I.C.H. 
SUTURED SCALP WOUND
SURGERY FOR A DEPRESSED
SKULL FRACTURE (CRANIECTOMY)
SURGERY FOR AN ACUTE SDH
(CRANIOTOMY)
THANK YOU