The document provides information on performing a quick neurological examination for head injuries. It examines consciousness level using the Glasgow Coma Score, pupillary response, evidence of skull fractures, and signs of injuries to the brain. Imaging tests like CT scans are crucial for assessing head injuries as they clearly show fractures and bleeding in the brain. CT scans with bone windows are typically needed initially, and sometimes a repeat scan within 12-24 hours can provide more information.

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
1. Subconjunctival haemorrhage
2. Bleeding from external auditory meatus
3. CSF rhinorrhoea/otorrhoea
4. Battle’s sign/Bilateral periorbital haematomas (Racoon eyes)
5. 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 4
To speech 3
To pain 2
None 1

4. 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

5. Head Injury Assessment
Glasgow Coma Score (GCS=3to15)
Verbal Response (V)
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1

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
12-24 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