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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Head injury introduction
• What are the causes of head injury?
• What are the symptoms of a head injury?
• What is the Glasgow Coma Scale?
• When should I contact a doctor about a head injury?
• How is a head injury diagnosed?
• How is a head injury treated?
• What is the prognosis for a head injury?
• How can a head injury be prevented?
• What about a head injury in infants and young children?
• Head Injury At A Glance
• Patient Comments: Head Injury - Cause
• Find a local Doctor in your town
• Head Injury Index

As with most injuries and illnesses, finding out what happened to the patient is very important. The physician or health care practitioner will take a history of the events. The information may be provided by the patient, people who witnessed the event, emergency medical personnel, and if applicable, the police. The circumstances are very important since it is important to find out the severity and intensity of the trauma sustained by the head.

Physical examination begins with assessing the ABCs (airway, breathing, circulation) to make certain that the patient is stable and does not need emergent life-saving interventions. This is especially important in those patients who are unconscious and may not be able to maintain their own airway or breathe on their own.

If the patient is not fully awake, the examination will initially try to determine the level of coma. The Glasgow Coma Scale number is useful in tracking whether the patient is improving or declining in function over time.

If no other injuries are found on examining the body, attention will be paid to the head and the neurologic exam. The health care practitioner will examine the patient for evidence of a basilar skull fracture, in which an injury has occurred to the bones that support the brain. Signs of this type of fracture include:

• bruising of around the eyes (called raccoon eyes),
  
  
• bruising behind the ear (Battle's sign),
  
  
• bleeding from the ear canal, or
  
  
• CSF leaking from the ear or nose.

The neurologic exam may include evaluation of the cranial nerves, the short nerves that leave the brain and control the face muscles, eye movements, swallowing, hearing and sight, among other functions.

If the neck is not injured, the exam may include evaluation of muscle tone and strength of the arms and legs; sensation in the extremities including light touch, pain, and vibration; coordination; and walking.

Depending upon the findings of the physical examination, a CT scan may be needed to look for bleeding in the brain.

It is important to remember that injuries to other parts of the body may also be present, and the evaluation of the head injury may occur at the same time as the evaluation of other injuries.