Head Injury Clinical Assessment

EXAMINATION

1. Lacerations and bruising

The presence of these features confirms the occurrence of a head injury, but traumatic intracranial haematoma can occur in patients with no external evidence of injury.

Beware of falling into the trap of diagnosing a depressed fracture when only scalp haematoma is present.

Soft fluctuant centre

Always explore deep lacerations with a gloved finger for evidence of a depressed fracture.

Soft fluctuant centre

Consider the possibility of a hyperextension injury to the cervical spine if frontal laceration or bruising is present.

2. Basal skull fracture

Clinical features indicate the presence of a basal skull fracture which may not be evident on routine skull X-ray or even on specific views of the skull base. If present, a potential route of infection exists with the concomitant risk of meningitis.

ANTERIOR FOSSA FRACTURE CSF rhinorrhoea

ANTERIOR FOSSA FRACTURE CSF rhinorrhoea

Bilateral periorbital haematoma

If the nasal discharge contains glucose, then the fluid is CSF rather than mucin.

Bruising limited to the orbital margins indicates blood tracking from behind.

Subconjunctival haemorrhage

Bruising under conjunctiva extending to posterior limits of the sclera indicates blood tracking from orbital cavity.

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