Imaging Studies

CT scan may show a fracture across the middle meningeal artery, or shifts in the brain from bleeds.

MRI scans are more sensitive than CT scans.

Diffusion tensor imaging is far better at showing white matter damage that can result from head trauma.^[20]

Quantitative EEG may be helpful.^[21]

Other Tests

Neuropsychological testing can help in the assessment of impairment after a head injury.

Histologic Findings

Head trauma, rapid acceleration and deceleration of the brain can damage axons. A cascade of damage can occur.

Glasgow Scale

The Glasgow Scale is frequently used to assess the severity of the initial injury. It consists of measurements of eye, verbal, and motor responses. The total score is found by summing the numbers for the three tests. GCS ≥ 13 is defined as minor, GCS 9–12 is defined as moderate, and GCS ≤ 8 is considered severe (coma).

Eyes

No eye opening
Eye opening in response to pain
Eye opening to speech
Eyes opening spontaneously

Verbal response

No verbal response
Incomprehensible sounds
Inappropriate words (no conversational exchange)
Confused (the patient responds to questions coherently but there is some disorientation and confusion)
Oriented

Motor response

No motor response
Extension to pain
Abnormal flexion to pain
Flexion/Withdrawal to pain
Localizes to pain (purposeful movements towards painful stimuli)
Obeys commands (the patient does simple things as asked)

Treatment & Management

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