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

Signs of Skull Base Fracture

Black Eye :Ant.Cranial fossa fracture

Battles Sign : Middle Cranial fossa fracture

Head Injury Assessment Glasgow Coma Score (GCS=3to15)

Eye Opening (E)

Spontaneous 4To speech 3To pain 2None 1

Head Injury Assessment Glasgow Coma Score (GCS=3to15)

Motor Response (M)

Obeys commands 6Localises pain 5Flexion 4Abnormal flexion (decorticate) 3Extension (decerebrate) 2None 1

Head Injury Assessment Glasgow Coma Score (GCS=3to15)

Verbal Response (V)

Oriented 5Confused 4Inappropriate words 3Incomprehensible sounds 2None 1

Imaging in head injury

Plain X Ray

CT scan MRI Angiography

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

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.

TOPOGRAM

EDH

EDH

EDH

EDH

SDH

SDH

SDH

EDH vs. SDH

Contusion

Contusion

Contusion