Types of Scalp Bruises (Contusions)

🟦 Subcutaneous: Collected between skin & aponeurosis. It is localized (circumscribed), small, and painful because it is under tension.

🟥 Subaponeurotic (Subgaleal): Collected under the aponeurosis. It is diffuse (large), soft, and less painful. Exam Tip: It causes "Black Eye" or bruising behind the ear because blood migrates freely.

2. Skull Fractures & Healing

🟦 Fissure Types: Diastatic (separates sutures, common in infants), linear , polar , bipolar and Multiple (crossing lines from multiple blows).

🟥 Healing Rule: Defects in the vault bone never repair with bone. They fill with a Fibrous Membrane (permanent infirmity).

🟦 Timeline: Membrane starts forming at 3 months and becomes thick/complete at 12 months.

3. Fracture Base of Skull (FBS)

🟥 Anterior Fossa: Damages CN I (Olfactory) & II (Optic). Causes Black Eye & nose bleeding.

🟦 Middle Fossa: Damages CN VII (Facial) & VIII (Auditory). Causes deafness & ear bleeding.

🟥 Posterior Fossa: Damages CN X, XI, XII. Causes visceral paralysis (bulbar palsy).

4. Traumatic Meningitis (vs. Pathological)

🟦 Traumatic: Onset is 1-2 weeks after injury. Pus collects at the scalp wound site. Organisms: Staph or Strept (secondary invaders).

🟥 Pathological: Caused by long-standing Otitis Media. Pus collects at the temporal bone. Onset is days (4-5).

5. Concussion

🟦 Definition: Sudden, transient loss of consciousness (5-15 mins) due to disturbance of the Reticular Formation.

🟥 Signs (Shock-like): Pale face, Low BP, Rapid weak pulse, shallow breathing, and abolished reflexes.

🟦 Fate: Complete recovery, Post-Concussion Syndrome (Amnesia, headache, irritability), or passes into Compression.

6. Lucid Interval

🟥 Concept: The "Talk and Die" phase. Temporary recovery between Concussion (unconscious) and Compression (unconscious again).

🟦 Significance: Classic in Extradural Hemorrhage.

🟥 Medicolegal: Patient may identify the assailant during this time. Defense may argue the blow wasn't fatal since the victim walked away initially. Rule: All concussion cases must be hospitalized 24h.

7. Compression

🟦 Signs (ICP): High BP, Slow Pulse (Vagal stimulation), and Effortless (projectile) vomiting.

🟥 Lateralization: The pupil on the injured side contracts then dilates (Fixed Dilated Pupil). Paralysis occurs on the opposite (contralateral) side

🟦 Hemorrhage in brain:

1- extradural hemorrhage: localized, usually traumatic due to tear of middle meningial artery

2- subdural hemorrhage: may be traumatic or pathological ( shake baby syndrome ) due to tear of subdural vessels

3- subarachnoid hemorrhage: usually pathological due to rupture of annurism of circle of Willis cause sudden death ☠️

4- intracerebral hemorrhage: cope or conture cope due to extension of subarachnoid hemorrhage

Lectures

Lectures