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Neurotrauma - What it is

Head Injury

Head injury is a common problem that patients present with to the accident and emergency department. All patients that loose consciousness after a head injury should seek medical attention for further medical evaluation. Often after the injury, we may not have lost consciousness but are a little dazed then later complain of symptoms of nausea, vomiting, giddiness and headache. These symptoms can vary in severity and may or may not resolve after several hours.

Patients with persistent symptoms who present to the accident and emergency department are evaluated and a CT brain scan may be performed if warranted. Depending on the results of the scan, patients are managed accordingly. One may be observed for several hours after some medical treatment and discharged if they subsequently improve. They may be admitted for closer monitoring if there are positive findings seen on the CT brain scan. Most symptoms often resolve or improve after 24 to 48 hours. There are however usually some long term residual symptoms such as memory loss, lack of ability to concentrate, ringing in the ears, tenderness or abnormal sensations over the region of scalp that was hurt. These residual symptoms can remain for up to 1 to 2 months after the head injury. If symptoms persist, further consultations with your doctor may warrant additional investigations.

In a minority of head injury patients, however, a more serious intracranial injury may have occurred. Such patients include those who remain drowsy or confused, have nausea or vomiting, severe headache, convulsions, drainage of spinal fluid from the ear or nose, develop weakness or loss of feeling in the extremities, pupillary asymmetry, double vision, or other neurological symptoms. In these individuals, a more thorough evaluation and closer observation is indicated because the concussive event may have caused a skull fracture and/or a hemorrhage over the surface of the brain (epidural or subdural hematoma) or in the brain (contuision). The CT scan of the brain which is performed will reveal these findings.

Glasgcow Coma Scale

The GCS is the most widely used method of defining a patient's level of consciousness and is used routinely by medical personnel to objectively describe a patient's neurological status. The patient's best motor, verbal and eye opening responses determine the GCS. A patient who is able to follow commands, is fully oriented and has spontaneous eye opening, scores a GCS of 15; a patient with no motor response, eye opening or verbal response to pain scores a GCS of 3. Patients with a GCS of 8 or less are considered to be in "coma". The utility of this scaling system is its objectivity, reproducibility and simplicity. When properly performed, the degree of inter-observer difference is negligible. Hence, a change in the GCS from one assessment to the next indicates a significant change in level of consciousness. It also has strong prognostic value in head injured patients regarding eventual neurological recovery. Head injury severity is generally categorized into three levels based on the GCS after initial resuscitation: mild: GCS 13-15, moderate: GCS 9-12, severe: GCS 3-8.

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The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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