injuries and poisoning
Overview of Head Injuries
Diagnosis of Head Injuries
A doctor's evaluation Computed tomography or sometimes magnetic resonance imaging Diagnosis of minor head injuries is based on a person’s symptoms and results of the examination. Injured people are checked for symptoms that indicate brain function could be worsening. These symptoms include the following: Repeated vomiting Severe headache Inability to feel or move an arm or leg Inability to recognize people or the surroundings Loss of balance Problems with speaking or seeing Lack of coordination Abnormal breathing Seizures These symptoms may develop hours or sometimes days after the original injury. If these symptoms occur, prompt medical attention is essential. If a head injury causes loss of consciousness, even briefly, immediate evaluation by a doctor is necessary. If doctors observe symptoms or findings that indicate possible brain injury, computed tomography (CT) or sometimes magnetic resonance imaging (MRI) is done. CT is usually done first because it can be done rapidly and can detect accumulated blood (hematomas), bruises (contusions), skull fractures, and sometimes widespread nerve damage (diffuse axonal injury). MRI may be useful later to check for diffuse axonal injury, injury to the brain stem (which controls levels of consciousness and vital body functions), and less obvious brain injuries that may not have been visible on CT. MRI can also help doctors predict prognosis. Skull x-rays are rarely helpful. Most head injuries are not serious. A serious head injury can be recognized based on certain symptoms. Many of these symptoms indicate that brain functioning is worsening. If any of them occur, medical attention should be sought immediately. Vomiting, irritability, or drowsiness that continues for more than 6 hours Loss of consciousness Inability to move or feel part of the body Inability to recognize people or the surroundings Inability to maintain balance Problems with speaking or seeing (for example, slurred speech, blurred vision, or blind spots) Drainage of clear fluid (cerebrospinal fluid) from the nose or ear Severe headache Diagnosis and treatment of severe head injuries are done at the same time. If the injury may affect other parts of the body (for example, after a motor vehicle crash) or the person is unconscious, an ambulance or 911 (in the United States) should be called. When the person who may have a severe head injury reaches the hospital, doctors and nurses do a physical examination to determine whether the injury is serious. First, they check vital signs, including heart rate, blood pressure, and breathing. A person who is not breathing adequately may need a ventilator. Doctors then quickly check the following: Whether the person is oriented and able to respond to commands Whether or how much stimulation (such as speaking, shouting, or squeezing a finger) is needed to make the person open their eyes Whether the person has basic brain function by checking the size of the pupils and their reaction to light, the ability to move the arms and legs, the use of language, coordination, and reflexes When doctors are sure that the person is not in immediate danger, a complete Neurologic Examination is done. This examination may help doctors determine the severity and location of the injury. Doctors examine infants and children thoroughly to check for bleeding in the retina, located at the back of the eye, and other signs of Diffuse Axonal Injury or Doctors periodically check the person to determine whether the person is improving or getting worse. CT is done to check for possible brain damage. Sometimes MRI is done in addition to CT. X-rays of the skull are usually unnecessary. They can identify skull fractures but reveal very little about brain damage. X-rays or CT of the neck is done when necessary to determine whether the neck is broken (because a strong blow to the head can also injure the neck). If doctors suspect that blood vessels are damaged, Angiography , The degree of external head injury may have little to do with the degree of brain injury. 