Inspection for traumatic brain injury of mild severity and headaches
Patients who complain of headaches that have arisen after an injury require additional examination to determine the severity and extent of the damage. The Glasgow Coma Scale (GCS) is a routine method by which the severity of a craniocerebral injury is determined (a possible score from 3 to 15). The total number of points depends on the patient’s responses, such as opening the eyes, motor and speech reactions to a certain stimulation.
Post-traumatic headache often occurs after mild traumatic brain injury, accompanied by a concussion. The signs indicating a slight traumatic brain injury are presented in table. 2-8. Often, after the injury, along with a headache, patients present a whole complex of somatic and psychological complaints, which manifests itself in a picture of post-concussion syndrome that develops in 43% of patients who have suffered a mild traumatic brain injury.
Symptoms of post-contusion syndrome:
1. Dizziness, instability or tinnitus.
2. Fatigue or sleep disorders
3. Impaired cognitive functions (attention, ability to concentrate, memory and control of mental processes)
4. Irritability, emotional lability or disinhibition 5. Depressive state
In patients who have suffered a traumatic brain injury, CT scan is the method of choice to exclude intracranial hemorrhage and fractures of the skull bones. In 7-8% of patients undergoing mild traumatic brain injury, changes in CT are detected. In tab. 2-10 reflect the factors, the presence of which indicates a high probability of detecting pathological findings on CT.
There is an interrelation between indicators of GCG and pathological CT-changes. So, with the sum of points for SCG 15, deviations from the norm on CT are found only in 5% of patients, and with the sum of points for SHKG 13 – in 30%. Patients with the absence of any signs described below, normal CT scan results and a score of SCG 15 can be observed on an outpatient basis, while patients with pathological changes on a CT scan or score of SCG <15 must be hospitalized.