Common Neuro Presentations - Head Trauma

Question 1

Key presenting complaint questions

Answer 1

BASICALLY TRYING TO WORK OUT IF THE BRAIN HAS BEEN AFFECTED IN ANY WAY

When
MOI, any protection - helmet?

Recall of event - any amnesia before or after?

• LOC
• neck pain
• headaches - esp if they don’t resolve with rest/analgesia

Question 2

Systemic review for

• high ICP
• skull fracture

Answer 2

Headache
Confusion, agitation
Vomiting
Blurred/double vision
Drowsy, confusion
Seizures
Limb weakness/tingling

Bruising around eyes, behind ears
CSF/blood from nose/ears

Question 3

Past medical history

• conditions
• drugs
• allergies
• FHx

Answer 3

Any medical conditions?
Medications?

HTN?
Clotting disorders?
Past head injury?
Past hospital admissions, surgery -ESP NEUROSURGERY INTERVENTIONS!
AC/AP use

Allergies and reactions

Question 4

SHx

Answer 4

Living

• who’s with you at home
• any dependents
• known to any carers?
• ability to do ADLs

Occupation
-work?

Substances - all increases ICH risk

• alcohol
• smoking
• recdrugs

Question 5

Examinations you would like to do

Answer 5

GCS
Pupil size responses
Signs of skull fracture
-raccoon eyes, Battle, CSF/blood from ears or nose

Cranial, upper, lower limb neuro examination

FBC, U&E - bleeding
G&S, INR - if surgery needed
CT head (and neck)

Question 6

When would you do a head CT

• within 1hr in trauma
• immediately
• within 8hrs of injury

Answer 6

GCS U13
GCS not 15 2hrs post injury
Suspected basal, depressed, open skull fracture
Focal deficit
Seizure
Vomiting 2+

LOC or amnesia since injury AND

• 65+
• coagulopathy
• dangerous MOI

No other CT head indications but on AC/AP