G HEAD INJURY AND BLEEDING IN BRAIN 51. If a person can die due to head injury after falling from standing position? Falls are extremely common, the severity not necessarily being directly related to the distance that the person falls. Many people die after falling from a standing position. Yet others survive a fall of many meters. Fall from standing position can occur if a person is drunk, from an assault, during illness (such as it or faint) etc. death can follow from a head injury, especially on to the back of the head. An occipital scalp laceration or fracture of the skull is not necessary to be present for cerebral damage (often frontal countercoup) to occur. There may also be a subdural or less often extradural haemorrhage, the later more common from a fall on the side of the head. 52. What are primary and secondary brain injuries? If the secondary brain injuries are preventable? Primary brain injury is caused at the time of impact. This include diffuse axonal injury, concussion, contusion and laceration. Secondary brain injury results from disturbances of brain by the traumatic event. It is subsequent or progressive brain damage developing as a result of primary brain injury. Hypoxia and hypotension are the two most common acute and treatable mechanisms of secondary injury. Types of secondary injuries includes: collection of blood/clot in the cranium, brain swelling, ischemia (restriction in blood supply causing shortage of oxygen in the tissue), infection, seizures and metabolic disturbances. No medication exists to halt the progression of secondary injury, but various clinical conditions presents opportunities to ind treatment that interfere with the damage process. 53. What is SDH (Sub dural haemorrhage)? How to differentiate between spontaneous and traumatic SDH? In most of the subdural hematoma, bridging veins remain the commonest source of bleeding. A common inding in subdural hematoma is multiple episode of re-bleeding. Often the clinical signs include headache and confusion. The absence of scalp injury or subscalp extravasation of blood and other non-signi icant injuries is MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 46