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 Subconjunctival haemorrhage Bleeding from external auditory meatus CSF rhinorrhoea/otorrhoea Battle’s sign/Bilateral periorbital haematomas (Racoon eyes) 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 4 To speech 3 To pain 2 None 1

Head Injury Assessment Glasgow Coma Score (GCS=3to15) Motor Response (M) Obeys commands 6 Localises pain 5 Flexion 4 Abnormal flexion (decorticate) 3 Extension (decerebrate) 2 None 1

Head Injury Assessment Glasgow Coma Score (GCS=3to15) Verbal Response (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 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