Head Injury (cont.)
How is a head injury diagnosed?
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.
Next: How is a head injury treated? »
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