Head Injury is a dynamic process and the injuries inside brain may evolve over time. This may vary from a few hours to many days. Hence, such patients need close observations for that period. A new hematoma may develop after some time and patient may become symptomatic after a few days of actual injury. Even a minor head injury especially if it is associated with transient loss of consciousness, vomiting or any seizure.
At least 24 hours admission in a hospital is highly recommended.
• Non-contract C.T. Head is the investigation of choice for head injury.
• MRI brain
• Cerebral Angiography
• X-ray of Skull
Plain CT scan:
A plain CT scan of the head is the initial and most informative investigation is a case of head injury. CT scan is now available in small cities or towns and takes just 30 seconds to examine the brain. Sometimes it may not pick up an injury within 6 hours of head injury, So it should be repeated later if the patient is symptomatic. It can be repeated daily or sos if the patient deteriorates later. Contrast CT is rarely done in case of head injury. CT cerebral angiography may be performed if vascular abnormality or injury is suspected.
MRI: Shows all the finding seen on CT scan. It specifically identifies the diffuse axonal injury, which can be missed on CT scan. However, MRI is time-consuming and expensive, So should be done only if indicated. MR cerebral angiography is a non- invasive method to know about the vascular architecture of brain and neck.
X-Ray: Skull shows fractures in the skull. It is now replaced by CT scan in most cases however it has its own medico legal importance. X ray skull is especially useful in pediatric Head injury cases when we anticipate a growing skull fracture. The patient can be followed by serial X-rays instead of CT scan thus preventing radiation exposure.
DSA (Digital Subtraction Angiography) may be occasionally required to diagnose a vascular injury. Treating s severe head injury: Head injuries should not be taken lightly. A moderate or severe head injury must always be treated in the hospital to minimize the risk of complications. Head injury is a dynamic process and new hematomas or infarcts may develop over days. Repeat CT scans may be needed to diagnose them. Frequent change in management plan after very close observation in Intensive care unit (ICU) or ward is key to success.