Generally, when patients suffer a TBI, they are brought to an emergency room for evaluation and treatment. They may be suffering such signs and symptoms as:

• Headache
• Nausea
• Confusion
• Problems concentrating and remembering
• Irritability
• Seizures
• Unconsciousness

Vital signs, a brief medical history, and the history of the event associated with the TBI are obtained. Once other serious injuries that may be life threatening are ruled out, physicians will evaluate the extent of the TBI.

A neurological exam will be performed to rule out any conditions requiring immediate surgery, such as a skull fracture, a hematoma, and elevated intracranial pressure (ICP). Once these conditions have been ruled out, tests such as x-rays, MRI’s, and CT scans may be done to provide images of the brain and the skull. These tests will help to determine if the skull is fractured and if pieces of bone from the fracture have penetrated into the brain itself.

A neurological exam will begin with the physician asking the patient a series of simple questions to determine if the patient is able to speak, interpret what is being said, and follow basic commands. A more detailed medical history will elicit any previous injuries, psychiatric treatment, learning disabilities, and use of alcohol and drugs. This information is important because a history of any of these conditions may account for some of the same symptoms found in TBI.

The GCS (Glasgow Coma Scale) is used to determine the patient’s level of consciousness. This scale provides a number from 3-15 that aids physicians in determining how severe the injury is, and helps them predict the patient’s chances of recovery. Scores of eight or below indicate a true coma and a severe TBI. A score of 9-12 suggests a moderate injury, while scores of 13 and above mean that the injury is mild. Other conditions, such as alcohol use, can lower the GCS, and physicians will take these conditions into account, hence the need for a thorough history.

How long unconsciousness lasts can also provide clues to the extent of the brain injury. A rule of thumb is that the longer the patient remains unconscious, the more severe the injury. The neurological exam may elicit signs of moderate to severe brain injury, such as slurred speech, difficulty swallowing (dysphagia), abnormal movements (including seizures), and an increase in muscle tone and reflexes. 

Tests

CT scan-provides a cross-sectional image of the brain

-can show physical abnormalities of the brain such as swelling and bleeding, which may require surgical intervention or immediate medical treatment. CT’s are usually the first imaging test done as they can detect changes very quickly.

MRI scan-generates computerized images of the brain using a large magnet and radio waves

-does not expose the patient to radiation

produces high resolution images of the brain

-more accurate at detecting TBI 24 to 48 hours after injury

Angiogram- examines the blood vessels in the brain

-dye is injected into an artery that supplies blood to the brain

-dye is introduced by catheter into the patient’s groin

ICP monitor-used to measure intracranial pressure, or pressure in the brain

A small wire, or tube, is placed on or into the brain and is connected to a pressure transducer that supplies the intracranial pressure as a number on a monitor.

EEG-measures electrical activity in the brain

-electrodes are applied to the patient’s scalp (electrodes are painless)

These tests do not always detect brain injury if brain damage is spread out to many areas of the brain or is subtle.