Head Injury

Abstract

The neurology or neurosurgical service is usually called if head injury is assessed as moderate to severe in degree. The Glasgow Coma Scale is pivotal in this evaluation. Timely assessment of these patients is necessary since they may have life-threatening injuries and if intervention is delayed, damage may be irreversible or fatal. Initial stabilization of the patient should be expeditious but mindful that the head and neck should be immobilized until radiological exclusion of cervical spine instability. The history should facilitate formulation of the mechanism of trauma, finding out about drug and alcohol use as well as the evolution of mental status changes. The examination may reveal neurological focality indicative of intracranial hemorrhage, edema, and complications including herniation syndromes. External features may include Battle’s sign, raccoon eyes, and evidence of CSF leak (CSF otorrhea and rhinorrhea) which implicate a base of skull fracture. Important diagnostic investigations include head imaging as well as a lumbar puncture when indicated. The specific management of head injury patients depends on the underlying cause. Neurosurgical consultation should be expeditious in cases of critical mental status deterioration and evidence of significant intracranial mass effect at high risk for herniation sequela.