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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
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

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HEAD_INJURY_d.ppt

  • 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.
  • 10. EDH
  • 11. EDH
  • 12. EDH
  • 13. EDH
  • 14. SDH
  • 15. SDH
  • 16. SDH