How is a head injury diagnosed?
As with most injuries and illnesses, finding out what happened to the patient is very important. The health care professional 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. Please be aware, even small head bumps or shaking can cause a brain injury.
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 skull may be examined for signs of trauma, including bruising (contusion) and swelling (hematoma). Palpating or feeling the skull may find evidence of a fracture. If a laceration is present, it is important to know if there is a broken bone beneath it. The face may be examined as well, since the face provides protection to the front of the head.
The health care professional may also 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 the tissues around the eyes (called raccoon eyes),
- bruising behind the ear (Battle's sign),
- bleeding from the ear canal, or
- cerebrospinal fluid 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.
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); and if the neck is determined not to be injured, the patient's ability to walk may be assessed.
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.