Traumatic Brain Injury Diagnosis

A traumatic brain injury occurs when the brain sustains damage due to some type of trauma, typically a fall, a motor vehicle accident, a sports injury or a violent act. When a person suffers a brain injury severe enough to cause certain symptoms, such as altered consciousness, confusion, behavior changes or obvious signs of trauma, the person will usually be taken to hospital for evaluation.

Upon Arrival in the Emergency Room

Once in the emergency room, a history of the incident preceding the visit to the ER will be taken. Anyone who was with the patient when the personal injury occurred will be questioned closely so that medical personnel tending to the victim will have a clear picture of what happened and how the victim responded. A quick medical history including allergies and current medications will be obtained. Depending on the severity of the injury (or suspected severity), specialists such as a neurosurgeon or neurologist may be asked to consult. Vital signs will be taken and an intravenous line may be inserted in case the need for medications arises.

Neurological Examination

A complete neurological exam will be done at some point, usually fairly soon after being admitted to the emergency room. Several functions may be assessed as part of a neurological exam including:

• Eye movement
• Reaction of pupils to light
• Orientation to person place and time
• Memory and recall
• Reflexes
• Gait and balance
• Presence of spinal fluid in ears or nose
• Muscle strength
• Sensation

The Glasgow Coma Scale (GCS) determines the victim’s eye movement, best motor response and best motor response and assigns a number up to 15. Scores of 13 and above correspond to a mild traumatic brain injury; a score of 9 to 12 indicates a moderate injury and a score of 8 or less represents coma or a severe brain injury. The GCS cannot be used alone to determine the severity of a head injury as other factors, such as the use of drugs and alcohol or a concurrent medical condition, may affect the scoring. Alterations in any of parameters included in the neurological exam may point to the possibility of a traumatic brain injury.

Diagnostic Tests

Several tests may be done to obtain more information regarding traumatic brain injury, such as the location of the injury, the presence of a foreign object in the brain, bleeding, swelling or other problems.

• CT Scanning- a CT scan is a specialized x-ray that produces cross-sectional images of the brain. It can detect swelling, bleeding and other problems and can be performed fairly quickly.

• MRI- MRIs generate computer images of the brain that are very detailed. The advantage of MRIs is that the victim is not exposed to radiation, as they are during a CT scan. MRIs may take up to an hour to perform.

These two tests are frequently performed when a traumatic brain injury is suspected to assess damage to the brain. EEGs, angiograms and monitoring of pressure within the brain may also be performed in certain cases.

Diagnosing a traumatic brain injury is complicated and may include several modalities, such as a comprehensive neurological exam and specialized tests. Often, specialists must give and interpret results of these exams and tests. Once the diagnosis is confirmed, attention will turn to deciding on the best course of treatment.

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