quick neurological examination conscious level (glasgow coma score ) pupillary response/limb...
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Quick Neurological Examination
Conscious level (Glasgow Coma Score ) Pupillary Response/Limb weakness Scalp lacerations / bruising-CSF leak,herniation of
brain matter Evidence of Skull fracture:Vault/Base
1. Subconjunctival haemorrhage2. Bleeding from external auditory meatus3. CSF rhinorrhoea/otorrhoea4. Battle’s sign/Bilateral periorbital haematomas (Racoon eyes)5. Facial nerve palsy
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Signs of Skull Base Fracture
Black Eye :Ant.Cranial fossa fracture
Battles Sign : Middle Cranial fossa fracture
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Head Injury Assessment Glasgow Coma Score (GCS=3to15)
Eye Opening (E)
Spontaneous 4To speech 3To pain 2None 1
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Head Injury Assessment Glasgow Coma Score (GCS=3to15)
Motor Response (M)
Obeys commands 6Localises pain 5Flexion 4Abnormal flexion (decorticate) 3Extension (decerebrate) 2None 1
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Head Injury Assessment Glasgow Coma Score (GCS=3to15)
Verbal Response (V)
Oriented 5Confused 4Inappropriate words 3Incomprehensible sounds 2None 1
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Imaging in head injury
Plain X Ray
CT scan MRI Angiography
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X Ray Skull
Lateral view• Sphenoid Sinus – look for Fluid /air Level• Pneumocele • Double Densities • Linear Fracture
PA View • Frontal Sinus - look for Fluid /air Level• Pineal Shift
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CT Scan
It is the most important investigation as it clearly depicts the extent of injury.
Usually a Plain CT head with bone window is required
Many times the first CT scan is done quite early a repeat CT scan should be done, preferably within 12-24 hours after injury.
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TOPOGRAM
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EDH
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EDH
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EDH
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EDH
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SDH
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SDH
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SDH
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EDH vs. SDH
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Contusion
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Contusion
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Contusion