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Laboratory studies
After the patient has been stabilized and an
appropriate neurologic examination has been
conducted, the diagnostic evaluation may begin.
Patients with TBI do not require any additional
blood tests beyond the standard panel of tests
obtained in all trauma patients.
A urine toxicology screen and an assessment of
the blood alcohol level are important for any
patient who has an altered level of consciousness
because any central nervous system depressant
can impair consciousness.
1.
Imaging studies
CT Scan
A CT Scan is the diagnostic study of choice in the
evaluation of TBI because it has a rapid
acquisition time, is universally available, is easy
to interpret, and is reliable
2. MRI
Neurologic assessment
The neurologic assessment begins with
ascertaining the GCS score. This is a screening
examination and does not substitute for a
thorough neurologic examination
Pupillary examination
A careful pupillary examination is a critical part of
the evaluation of patients with TBI, especially in
patients with severe injuries
Treatment
Closed head injury
Mild head injury
Patients who are discharged after mild head injury
should be given an instruction sheet for head injury
care. The sheet should explain that the person with
head injury should be awakened every 2 hours and
assessed neurologically. Caregivers should be
instructed to seek medical attention if patients
develop severe headaches, persistent nausea and
vomiting, seizures, confusion or unusual behavior, or
watery discharge from either the nose or the ear.
Penetrating trauma
Complications
Hydrocephalus
Seizures
Vascular injuries
Infections
HEAD INJURY
Dr. Ronny. Y., Sp. S
Concussion
Mild concussions are associated with sequelae.
However, a slightly greater injury is associated
with both anterograde and retrograde amnesia
(inability to remember events before or after the
injury). The amount of time that the amnesia is
present correlates with the severity of the injury.
In all cases the patients develop postconcussion
syndrome, which includes memory problems,
dizziness, tiredness, sickness and depression.
Epidural hematoma
Epidural hematoma (EDH) is a rapidly
accumulating hematoma between the dura mater
and the cranium. These patients have a history of
head trauma with loss of consciousness, then a lucid
period, followed by loss of consciousness. Clinical
onset occurs over minutes to hours. Many of these
injuries are associated with lacerations of the middle
meningeal artery. A"lenticular", or convex, lensshaped extracerebral hemorrhage will likely be
visible on a CT scan of the head.
Subdural hematoma
Subdural hematoma occurs when there is tearing
of the bridging vein between the cerebral cortex
and a draining venous sinus. At times they may
be caused by arterial lacerations on the brain
surface.
A crescent shaped hemorrhage compressing the
brain will be noted on CT of the head.
Surgical evacuation is the treatment.
Complications include uncal herniation, focal
neurologic deficits
Cerebral contusion
Cerebral contusion is bruising of the brain tissue.
The majority of contusions occur in the frontal
and temporal lobes. Complications may include
cerebral edema and transtentorial herniation.
The goal of treatment should be to treat the
increased intracranial pressure.
Symptoms
Patients with concussion may have a history of
seconds to minutes unconsciousness, then normal
arousal. Disturbance of vision and equilibrium
may also occur.
Common symptoms of head injury include coma,
confusion, drowsiness, personality change,
seizures, nausea and vomiting, headache and a
lucid interval, during which a patient appears
conscious only to deteriorate later.