1. 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

2. Signs of Skull Base Fracture
Black Eye : Ant.Cranial fossa fracture
Battles Sign : Middle Cranial fossa fracture

3. Head Injury Assessment Glasgow Coma Score (GCS=3to15)
Eye Opening (E)
Spontaneous
To speech
To pain
None

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

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

6. Imaging in head injury
Plain X Ray
CT scan
MRI
Angiography

7. 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

8. 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 hours after injury.

9. TOPOGRAM

10. EDH

11. EDH

12. EDH

13. EDH

14. SDH

15. SDH

16. SDH

17. EDH vs. SDH

18. Contusion

19. Contusion

20. Contusion