Emergency Medicine Book

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Head InjuryAka: Head Trauma

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  1. See Also
    1. Concussion in Sports
    2. Postconcussion Syndrome
  2. Pathophysiology
    1. Intracranial Pressure (ICP) association with injury
      1. Note measurements are in mmHg, not cmH2O
      2. Normal: 10 mmHg ICP
      3. Abnormal: 20 mmHg ICP
      4. Severe: 40 mmHg ICP
      5. Herniation: 50 mmHg ICP
    2. Cushing's Response
      1. Hypertensive response in face of increased ICP
      2. Helps maintain cerebral perfusion
      3. Do not use antihypertensives to lower Blood Pressure
        1. Results in decreased brain perfusion
  3. Assessment
    1. Glasgow Coma Scale
    2. Pupil exam
    3. Neurologic Exam
    4. Alcohol or drug intake history
    5. Hypotension seen in pediatric closed Head Injury
      1. Patrick (2002) Am J Surg 184:555
    6. Signs Skull Fracture
      1. Vault skull Fracture
      2. Basilar skull Fracture
        1. CSF Rhinorrhea or Otorrhea
        2. Hemotympanum
        3. Post-auricular bruising (Battle's Sign)
        4. Orbital bruising (Raccoon's Eyes)
        5. CN VII palsy (Bell's Palsy)
    7. Signs Intracranial Injury
      1. Focal
        1. Epidural hemorrhage
        2. Subdural hemorrhage
        3. Intracerebral hemorrhage
      2. Diffuse
        1. Mild Concussion
        2. Classic Concussion
        3. Diffuse axonal injury
  4. CT Head Indications
    1. Head CT in all cases of moderate or severe Head Injury
    2. Mild Head Injury Indications
      1. See Head Injury CT Indications in Adults
      2. See Head Injury CT Indications in Children
  5. Management
    1. See Management of Mild Head Injury
    2. See Management of Moderate Head Injury
    3. See Management of Severe Head Injury
    4. Avoid Systemic Corticosteroids (increases mortality)
      1. Roberts (2004) Lancet 364:1321

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