The reader is referred to Chapterii4.1.14 for many of the management principles relevant to patients with a head injury. Management of early neurobehavioural problems

Behavioural problems, and mental symptoms, arising in the days and weeks following a brain injury should be regarded as a flag to indicate the need to check on the progress of recovery. The history needs to be reviewed, paying attention to the period leading up to injury. The patient will need to be examined physically, paying particular attention to the possibility of fever, and given a reasonably thorough neurological examination. It is essential to document the conscious level and orientation. Routine blood tests should be performed, and blood gases and a chest radiograph considered. The medication needs to be scrutinized. A neurological or neurosurgical opinion may be needed with a view to considering neuroimaging or an EEG. A lumbar puncture, for example looking for meningitis, should probably not be done without specialist advice.

Specific causes of deterioration after head injury are listed in BoxZ Once these have been excluded then the principle of care should be to allow recovery to take place in a safe environment, paying attention to the general principles of the care of the delirious or demented patient as indicated. Explanation to the patient and his or her family of what is happening, is required.

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