Head Trauma

Rapid clinical assessment using the Glasgow Coma Scale, combined with a focused neurological examination, guides initial triage and the urgency of imaging. Non-contrast CT of the head is the standard first-line imaging in acute head trauma and is highly sensitive for detecting intracranial hemorrhage, skull fractures, cerebral edema, and midline shift. MRI is used for further evaluation when the CT does not explain the clinical picture, particularly for detecting diffuse axonal injury or posterior fossa pathology. Intracranial pressure monitoring via a surgically inserted device provides critical data in patients with severe TBI admitted to the intensive care unit.

Management depends on injury type and severity. Patients with mild head trauma and no intracranial hemorrhage on CT are observed for symptom progression and receive education about concussion recovery. Any patient with an expanding intracranial hemorrhage, a depressed skull fracture, or clinical signs of raised intracranial pressure requires urgent neurosurgical evaluation. Emergency craniotomy is performed to evacuate epidural or significant subdural hematomas; decompressive craniectomy may be required for refractory intracranial hypertension. In the intensive care unit, medical management of elevated ICP includes head-of-bed elevation, osmotherapy with mannitol or hypertonic saline, sedation and analgesia, and temperature management. Prevention of secondary injury through strict maintenance of normal blood pressure, oxygenation, blood glucose, and avoidance of fever is as important as any specific treatment.