الفهرس 
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Abstract
The cost to society of head trauma is staggering, from both an economic and social standpoint. Appropriate management of TBI requires an understanding of the pathophysiology of head injury. In addition to the obvious functional differences, the brain has several features that distinguishes it from other organ systems. The most important one of these differences is that the brain is contained within the skull, a rigid and inelastic container. Because the brain is housed within this inelastic container, only small increases in volume within the intracranial compartment can be tolerated before pressure within the compartment rises dramatically.
In the present work, 100 cases of head trauma were studied; all of them were exposed to various types of head trauma of age (4 up 65 years), any sex, dead cases (26) and living cases (74),(after consenting of the patients or their relatives).
Investigations were used for dead cases:
1-Plain x-ray
2-CT scan
3- Autopsy procedure.
Investigations were used for living cases :
1- Neuropsychic assessment
2- Plain x ray
3- Computerized tomography (CT scan)
4- Magnetic resonance image (MRI)
5- Magnetic resonance angiography(MRA)
6- Electroencephalography(EEG)
7- Vision acuity tests
8- Fundoscopy
9- Hearing tests
10- IQ tests and following up for 6 months.
Cases of the study were selected from the forensic department of BeniSuef at period 2008 – 2010.Cases were grouped according to:
1- Age Groups ( 1- <10 years, 2- 10- less than 25 years, 3- 25- less than 50 years and 4- 50 years and above ).
2- Gender (male, female).
3- Types of Trauma (Blunt, cut, firearm, penetration, mixed).
4- Type of Causative Agents (Stick, axe, firearm weapons, car accident, iron rod).
5- Sites of Trauma (more than one site, parietals, temporals, occipital, frontal, face).
6- Degree of Head Trauma Severity regarding to Level of Consciousness (according to Glasgow coma scale) (severe, moderate, mild) and death incidence.
7- Open or Closed Head Trauma.
8- Pathological Sequelae of Head Trauma and Follow-up:
1- Types of Scalp Findings with Follow-up.
2- Types of Skull Fractures at Onset of Head Trauma and Follow-up.
3- Types of Intracranial hge. at Onset of Head Trauma and Follow-up. 4- Types of Intracerebral Injuries at Onset of Head Trauma and Follow-up.
9- Clinical Sequelae of Head Trauma:
1- Complete Recovery
2-Permanent Infirmity types (cognitive, motor, epilepsy, cranial nerve affection, mixed infirmities).
3-Death in relation to Onset of Head Trauma (1-at day of trauma, 2- within 3 months , 3- within more than 3 months up to 6 months).
The following results were obtained:
1- Regarding to Age Groups exposed to Head Trauma:
• Age Group <10 years represented (1%), 10- less than 25 years (16%), 25- less than 50 years (61%) and 50 - above (22%).
2- Regarding to Gender of Head Trauma:
• Males represented (84%), females (16%).
3-Regarding to Types of Head Trauma:
• Blunt Trauma represented (61%), cut trauma (25%), firearm (10%), Penetrating and mixed trauma (cut and blunt) (2%) for each.
4-Regarding to Sites of Head Trauma:
• More than one site (mixed) were the most frequent to be traumatized (43%), parietal areas (right and left) (27%), frontal area (15%), occipital area (8%), temporal areas (right and left) (5%), face (2%).
5-Regarding to Causative Agents of Head Trauma:
• Stick was the most frequent and represented (45%), axe (25%), car accident (16%), firearm (10%), stick with an axe (mixed)(2%).
6- Regarding to Open or Closed Head Trauma:
• Closed Trauma represented (67%) and Open Trauma (33%).
7-Regarding to Head Trauma Severity ( Consciousness Level (GCS) and Death Incidence):
• Severe coma cases were the most frequent and represented (42%), moderate coma (5%), mild coma (35), conscious cases (31%) and cases died immediately at onset of trauma (19%).
8- Regarding to Skull Fractures at Onset of Head Trauma: total cases of skull fractures represented 59% of all cases of head trauma where:
• Mixed (comminuted depressed and fissure fractures) represented 34%, fissure fractures(23%) and depressed fractures(2%).
9- Regarding to Intracranial Haemorrhages at Onset of Head Trauma: total cases with intracranial haemorrhages represented (41%) where:
• Mixed hges. (extradural, subdural, ventricularhges.) was the most frequent and represented (18%), extradural hge. (17%) and 3% for each subdural hge. and subarachnoid hge.
10- Regarding to Intracerebral Findings at Onset of Head Trauma: total cases with intracerebral findings represented 42% of all cases of head trauma where:
• Contusion represented 24%, (contusion and laceration) (16%) and (contusion, laceration and embedded firearm missiles)(2%).
11- Regarding to Scalp Findings Follow-up: total living cases for follow-up were 77% of cases of head trauma where:
• Healed scalp represented 73% and subgaleal calcified haematoma(4%).
12-Regarding to Skull Findings Follow-up: total living cases for follow-up were 77% of cases of head trauma where:
• No apparent lesion represented 57%, trephine operation (11%), depressed fracture (8%) and calcified maxillary sinus (1%).
13- Regarding to Intracranial Haemorrhages Follow-up: total living cases for follow-up were 77% of cases of head trauma where:
• No apparent lesion represented 66%, extradural haematoma (6%), subdural haematoma (3%) and subdural hygroma (2%).
14- Regarding to Intracerebral Findings Follow-up: total living cases for follow-up were 77% of cases of head trauma where:
• No apparent lesion represented 50%, encephalomalacia (16%), encephalomalacia and ventricular dilatation (4%), cortical atrophy (3%), contusion with sepsis (3%) and dysmyelination(1%).
15- Regarding to Clinical Sequelae of Onset of Head Trauma:
• Permanent infirmity represented 39%, completele recovery (35%) and death cases (26%).
16- Regarding to Deaths due to Onset of Head Trauma: total deaths were 26% of cases where:
• 23 cases (88%) of deaths were at day of trauma, 2 cases (8%)of deaths were within 3 months of trauma and one case (4%) of deaths was within more than 3 months up to 6 months of trauma.
17-Regarding to Types of Permanent Infirmity of Head Trauma: Total cases of permanent infirmity were 39% of all cases where:
• -Mixed infirmities represented 17%, pure cognitive(8%), pure cranial nerve affection (7%), pure post-traumatic epilepsy (4%), pure motor (3%).
18- Regarding to Death Causes due to Head Trauma: Total deaths were 26% where :
• 17% of all cases (65% of deaths) died with brain contusion and laceration, 4% of all cases (15% of deaths) died with extradural haemorrhage, 3% of all cases (12% of deaths) died with brain contusion and sepsis and 2% of all cases (8% of deaths) died with brain contusion and meningeal haemorrhage.