Introduction

Head injuries are one of the most common causes of disability and death in humans. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bones, or from internal bleeding and damage to the brain.

There are many causes of head injury in children and adults. The most common traumatic injuries are from motor vehicle accidents (automobiles, motorcycles, or struck as a pedestrian), from violence, from falls, or as a result of child abuse. Subdural hematomas and brain hemorrhages (called intraparenchymal hemorrhages) can sometimes happen spontaneously.

When there is a direct blow to the head, the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a COUP (pronounced COO) Lesion. As the brain jolts backward, it can hit the skull on the opposite side and cause a bruise called a Counter COUP Lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

Management

The patient was rushed in to the Emergency at Chandan Hospital, Lucknow. He was bleeding from his forehead and was in an unconscious state. The emergency staff responded quickly and discovered the head injury with exposed RT frontal brain and communicated frontal bone fracture. They further investigated and figured out that the patient’s right pupil was dilated & non-reactive and left pupil was pinpoint non-reactive.
Further, test like CT scan was performed on the patient to determine the extent of his head injuries. Following were the findings:

The patient underwent surgery under Dr. Mohd Iqbal who did fixation of multiple fractured segments of skull bone with miniplate and screws. Alignment of the right upper orbital rim was also performed. Fractures involving frontal bone are rather uncommon. Injuries to this bone are rather critical because of its proximity to the brain. Due to excellent treatment, timely visits, and regular monitoring, the patient recovered successfully without any further complications.