Head injury and unconsciousness

Question 1

Definitions

Answer 1

The clinical terms used to describe brain injury of concussion, confusion and laceration

• indicate minor to major degrees of a similar injury.

Life-threatening injuries include extradural and subdural haematomas

The Glasgow coma scale can be used as a guide to the conscious state.

Question 2

Illustration of sites of subdural and extradural haematomas in relation to the dura, skull and brain

Answer 2

Question 3

Glasgow coma scale

Answer 3

Eye opening (E)

• Spontaneous opening 4
• To verbal command 3
• To pain 2
• No response 1

Verbal response (V)

• Orientated and converses 5
• Disoriented and converses 4
• Inappropriate words 3
• Incomprehensible sounds 2
• No response 1

Motor response (M)

Obeys verbal command 6

Response to painful stimuli

• Localises pain 5
• Withdraws from pain stimuli 4
• Abnormal flexion 3
• Extensor response 2
• No response 1

Coma score = E + V + M

• Minimum 3
• Maximum 15
• If 8–10: take care—monitor the airway

Question 4

Extradural haematoma

Answer 4

Following head injury there may be a short lucid interval followed by loss of consciousness.

The pt is restless, confused, irritable,

• has severe headache and
• develops neurological signs.

Question 5

Classic conscious states leading to extradural haematoma after injury

Answer 5

Question 6

Investigation:

Answer 6

skull X-ray

CT scan

Lumbar puncture contraindicated

Question 7

Management:

Answer 7

urgent decompression of haematoma

Question 8

Subdural (epidural) haematoma

Answer 8

The responsible injury may seem trivial esp. in elderly

• and the haematoma may be acute, subacute and chronic.

Consider it in a person with:

• personality change
• headache
• slow unsteady movements and
• fluctuating conscious level.

Investigate and treat as above.