Felis ISSN 2398-2950

Head: trauma

Contributor(s): David Godfrey, Elisa Mazzaferro, Simon Platt

Introduction

  • Cause: road traffic accident/hit by car, falls, kicks and gunshot injuries.
  • Signs: head trauma may be evident from visible wounds or from a dysfunction of one of the organs in the head, eg the brain, nose or tongue. Acute onset of neurological signs related to area of brain injury.
  • Treatment: emergency care should be given to establish an airway and to ensure that breathing and circulation are adequate. Decrease intracranial pressure; remove compressive lesions such as hematomas and depressed fractures; treat cerebral edema; treat seizures if they occur.
  • Eye trauma may need urgent treatment to maximize the chances of retaining sight.
  • Prognosis: guarded - depends on neurological status at presentation, response to emergency treatment, as well as presence of concurrent systemic injuries.

Pathogenesis

Etiology

  • Road traffic accident/hit by car.
  • Fight with another cat or bitten by dog.
  • Other causes are falls and non-accidental injury (gunshot injury, kicks).

Predisposing factors

General

  • Un-neutered male cats more prone to wandering.

Pathophysiology

  • The primary injury may initiate a number of secondary pathophysiological sequelae such as:
    • Metabolic alterations in neuronal or glial cells.
    • Impairment of vascular supply to normal tissue (ischemia).
    • Impairment of cerebrovascular autoregulation.
    • Hemorrhage (intraparenchymal, intraventricular, extradural or subdural).
    • Irritation (seizure generation).
    • Obstruction of the ventricular system.
    • Edema formation.
    • Production of physiologically active products.
    • Increased intracranial pressure (ICP).

Intracranial pressure after head trauma

  • Increases in intracranial pressure Intracranial pressure measurement are often responsible for clinical decline in many animals after head trauma.
  • After head trauma, the volume of the brain tissue compartment increases usually due to edema or hemorrhage.
  • As the brain tissue compartment increases, the cerebrospinal fluid and the blood compartments must decrease or intracranial pressure will increase (compensation).
  • Once the ability for compensation is exhausted, a further small increase in intracranial volume will result in dramatic elevations of ICP, with the immediate onset of clinical signs.

Timecourse

  • Minutes to hours.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Bar-Am Y, Pollard R E, Kass P H & Verstraete F J M (2008) The diagnostic yield of conventional radiographs and computed tomography in dogs and cats with maxillofacial trauma. Vet Surg 37, 294-299 PubMed.
  • Platt S R, Abramson C J, Garosi L S (2005) Administering corticosteroids in neurologic diseases. Vet Clin North Am Small Anim Pract 27, 210-220.
  • Syring R A (2005) Assessment and treatment of central nervous system abnormalities in the emergency patient. Vet Clin North Am Small Anim Pract 27, 343-358 PubMed.
  • Gordon P N, Dunphy E, Mann F A (2003) A traumatic emergency: handling patients with head injuries. Vet Med 98, 788-798.
  • Syring R S, Otto C M, Drobatz K J (2001) Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999). JAVMA 218, 1124-1129 PubMed.
  • Dewey C W (2000) Emergency management of the head trauma patient. Vet Clin North Am: Sm Anim Pract 30, 207-225.
  • Ghajar J (2000) Traumatic brain injury. Lancet 356, 923-929.
  • Proulx J & Dhupa N (1998) Severe brain injury - Part 1, Pathophysiology. Comp Cont Ed Pract Vet 20, 897-905.
  • Proulx J & Dhupa N (1998) Severe brain injury - Part 2, Therapy. Comp Cont Ed Pract Vet 20, 993-1005.
  • Hopkins A L (1996) Head trauma. Vet Clin N A 26, 875-891.
  • Dewey C W, Budsberg S C & Oliver J E (1992) Principles of head trauma management in dogs and cats - Part 1. Comp Cont Ed Pract Vet 14, 199-207.
  • Rudy R L & Boudrieau R J (1992) Maxillofacial and mandibular fractures. Vet Med Surg 7, 3-20.
  • Kapatkin A & Matthiesen D T (1991) Feline high-rise syndrome. Comp Cont Ed Pract Vet 13, 1389-1397.

Other sources of information

  • Shores A (1983) Craniocerebral trauma. In: Current Vet Therapy X: Small Anim Pract. W B Saunders. pp 847-854.


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