Approximately 1 million patients present to hospital each year in the UK with a head injury, 90% of whom have a ‘mild’ or ‘minor’ head injury, whilst 5% have a ‘moderate’ and 5% have a ‘severe’ head injury. (Kay and Teasdale 2001).
The National Institute of Clinical Excellence, however, note that this may be an under-estimate, and that 700,000 patients attend accident and emergency departments in England and Wales each year with a head injury, and that in England in 2000/2001 there were 112,978 hospital admissions for head injury, of whom 72% were male, and 30% were children under 15 years of age. (NICE 2003).
Death from head injury in the UK has an incidence of 6-10 per 100,000 population each year, equivalent to 0.2% of patients attending accident and emergency departments for their injury. The majority of these fatalities are associated with ‘moderate’ (Glasgow Coma 9-12) or ‘severe’ (GCS 8 or below).
Adelson (1974) notes that head injuries are of particular importance in forensic medicine because:
- the head is often targetted in assaults
- the head can easily be injured when a person is knocked or pushed to the ground, and
- the brain and its coverings are more vulnerable to a degree of trauma that would rarely be lethal if applied to other areas of the body.
Frontal contusions and brain swelling (CT scan)
assessing the severity of head injury - the Glasgow Coma Score/ Scale (GCS)
- Kay A and Teasdale G (2001), 'Head injury in the United Kingdom', World Journal of Surgery 25:1210-1220
- National Institute of Clinical Excellence (NICE) (2003), 'Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults', http://guidance.nice.org.uk/CG4/guidance/pdf/English
- Adelson L (1974), 'The pathology of homicide', Charles C Thomas, Springfield USA (http://www.ccthomas.com/details.cfm?P_ISBN13=9780398030001)
revise your anatomy
lateral view of human skull (source: eskeletons)
Revise your anatomy of the head, brain, and skull with the help of anatomy resources on the web ..
- eskeletons (very clear photographs of much of the skeleton, labelled with attachments, and including movies)
- skull bones (QTVR movies of each skull bone)
- skull bones illustrations via Instant anatomy
- skull bone anatomy - interactive flash resource with quizzes
- skull base anatomy and pathology flash animation
- neuroanatomy - coronal slices with labelling option, 3D3D vascular models, and quizes (name the labelled structures in fixed brains)
- whole brain atlas (CT/ MRI sequences, with labels, and movie capability for each sequence) - MR sequence movie
- head and neck vasculature - table of structures, origins etc
- radiographic anatomy, including skull (wikiradiography)
- brain neuroanatomy via MRI - labelled views in three planes (Wayne State University)
- neuroanatomy and physiology 'virtual labs' (Stanford University)
- general anatomy photographs, descriptions, and animations (anatomyexpert.com)
- label the structures
- AnatomyLab quizes
- human brain atlas - gross anatomy, imaging and virtual microscopy (the human brain.info teaching resource) with additional teaching materials in German
revise your skull anatomy - foramina and structures passing through them
revise your neuroanatomy
blood supply to the brain
revise your anatomy - blood vessels on the base of the brain and brainstem
Source: Neuroanatomy @ the University of British Columbia (follow link for full size version)
forensic neuropathology and associated neurology
essential forensic neuropathology