Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-23T18:01:25.240Z Has data issue: false hasContentIssue false

Chapter 4 - Clinical Assessment of the Head-Injured Patient

Published online by Cambridge University Press:  28 April 2020

By
Amr H. Mohamed ,
Peter C. Whitfield  and
Deva S. Jeyaretna
Edited by
Peter C. Whitfield ,
Jessie Welbourne ,
Elfyn Thomas ,
Fiona Summers ,
Maggie Whyte  and
Peter J. Hutchinson
Peter C. Whitfield
Affiliation:
Derriford Hospital, Plymouth
Jessie Welbourne
Affiliation:
University Hospitals, Plymouth
Elfyn Thomas
Affiliation:
Derriford Hospital, Plymouth
Fiona Summers
Affiliation:
Aberdeen Royal Infirmary
Maggie Whyte
Affiliation:
Aberdeen Royal Infirmary
Peter J. Hutchinson
Affiliation:
Addenbrooke’s Hospital, Cambridge
Get access

Summary

The rapid and accurate clinical assessment of a head-injured patient is crucial. The initial management should be governed by attention to the airway, breathing and circulation according to the principles of the Advanced Trauma Life Support (ATLS) care system. This is vital not only to identify immediately life-threatening injuries but also to prevent secondary cerebral insults. The cervical spine should be immobilised, since patients with a head injury may also harbour a cervical spine injury.1 The level of consciousness and pupil size and reaction should be determined early and at regular intervals when managing patients with TBI.

Type
Chapter
Information
Traumatic Brain Injury
A Multidisciplinary Approach
 , pp. 34 - 42
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mercer, SJ, Guha, A. Assessing the implementation of guidelines for the management of the potentially injured cervical spine in unconscious trauma patients in England. J Trauma 2010 Jun;68(6):1445–50.Google Scholar
Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974 Jul 13;2(7872):81–4.Google Scholar
Fischer, M, Rüegg, S, Czaplinski, A, Strohmeier, M, Lehmann, A, Tschan, F, et al. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care 2010;14(2):R64.CrossRefGoogle ScholarPubMed
Jennett, B, Bond, M. Assessment of outcome after severe brain damage. Lancet 1975 Mar 1;1(7905):480–4.Google Scholar
Campbell, WW, DeJong, RN, Haerer, AF. DeJong’s the neurologic examination: incorporating the fundamentals of neuroanatomy and neurophysiology. 6th edn. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005.Google Scholar
Sinnatamby, CS, Last, RJ. Last’s anatomy: regional and applied. Edinburgh: Elsevier/Churchill Livingstone; 2006.Google Scholar
Feldman, JS, Farnoosh, S, Kellman, RM, Tatum, SA. Skull base trauma: clinical considerations in evaluation and diagnosis and review of management techniques and surgical approaches. Semin Plast Surg 2017 Nov;31(4):177–88.Google ScholarPubMed
Collier, J. The false localising signs of intracranial tumour. Brain 1904;27:490–508.CrossRefGoogle Scholar
Larner, AJ. False localising signs. J Neurol Neurosurg Psychiatry 2003;74:415–18.Google Scholar
Kernohan, JW, Woltman, HW. Incisura of the crus due to contralateral brain tumor. Arch Neurol Psychiatry 1929;21:274–87.Google Scholar
Lofgren, J, von Essen, C, Zwetnow, NN. The pressure–volume curve of the cerebrospinal fluid space in dogs. Acta Neurol Scand 1973;49(5):557–74.Google Scholar
Lofgren, J, Zwetnow, NN. Cranial and spinal components of the cerebrospinal fluid pressure-volume curve. Acta Neurol Scand 1973;49(5):575–8.Google Scholar
Rhoton, AL Jr. Tentorial incisura. Neurosurgery 2000;47(3 Suppl):S131–53.CrossRefGoogle ScholarPubMed
Parizel, PM, Makkat, S, Jorens, PG, et al. Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage). Intens Care Med 2002;28(1):85–8.Google Scholar
Wheeler, DM, Hobbs, CJ. Mistakes in diagnosing non-accidental injury: 10 years’ experience. Br Med J 1988 296:1233–6.Google Scholar
Minns, RA, Busuttil, A. Four types of inflicted brain injury predominate. Br Med J 2004;328:766.Google Scholar
Geddes, JF, Vowles, GH, Hackshaw, AK, Nichols, CD, Scott, IS, Whitwell, HL. Neuropathology of inflicted head injury in children I. Patterns of brain damage. Brain 2001;124:1290–8.Google Scholar
Geddes, JF, Vowles, GH, Hackshaw, AK, Nichols, CD, Scott, IS, Whitwell, HL. Neuropathology of inflicted head injury in children II. Microscopic brain injury in infants. Brain 2001;124:1299–306.Google Scholar
Lantz, PE, Sinal, SH, Stanton, CA, Weaver, RG Jr. Perimacular retinal folds from childhood head trauma. Br Med J 2004;328:754–6.Google Scholar
Squier, W. Shaken baby syndrome: the quest for evidence. Dev Med Child Neurol 2008;50:10–14.CrossRefGoogle ScholarPubMed
Reece, RM. The evidence base for shaken baby syndrome: response to editorial from 106 doctors. Br Med J 2004;328:1316–17.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×