Brain trauma can be caused by many things, the most obvious being a trauma to the head. Additionally the brain can suffer damage from lack of nutrients to the brain cells, clots loss of blood flow, cancer or hemorrhaging. Even though there are different causes, evaluation and testing is similar for a neurological emergency.
History Exam
If the person who has had trauma is conscious, try to get as much background information as possible. While she is talking, listen for articulation of words as well as appropriate use of words. Make notations to any altered patterns. The major history questions include a family or personal history of stroke, blood clots, heart problems, high blood pressure, high cholesterol and cancer. Additionally, if it is not visually obvious ask about any recent trauma. Ask about recent head aches or difficulty moving or speaking.
Physical/Neurological Exam
All of the tests done in the neurological and physical exam are key to figuring out what kind of trauma the brain is suffering and what images to obtain. With a more severe presentation, less is performed and imaging and treatment is started immediately. The physical exam will start with vitals--respiration rate, pulse and blood pressure. Obvious signs of injury like signs of swelling, bleeding, bruising or depressions in the face and skull are noted. (Reference 3) Any of these outward signs could be an indication of a deeper problem and significant trauma. A very common sign of skull fracture is a battle sign, which is bruising behind the ear and bruising and swelling under the eyes. (Reference 3) Neurological testing will test the nerves through deep tendon reflex, muscle and sensory testing on several areas of the face and extremities. An eye exam will be performed as well, which involves looking into the eye, responsiveness to light as well as how the eyes move and track. (Reference 1)
In addition, questions will be asked to determine orientation to name, date, time and place. More advanced questions will involve testing basic math, spelling and memory skills if no obvious trauma is apparent. Any rapidly decreasing vitals, levels of consciousness or paralysis are sent immediately for imaging and treatment.
Imaging Tests
MRI/CT are both used for imaging inside the head. MRI uses a magnet to obtain its imaging, where a CT uses x-ray. Both imaging choices can be done if one does not show any significant signs of trauma. Depending on the determination from the physical exam, an arthrogram can be done. An arthrogram looks for signs of narrowing (stenosis) or blockage in the blood vessels in the neck and head. Alternatively or additionally, an ultrasound can be performed to look at the vessels in the neck. (Reference 2)
Laboratory Tests
Urine, blood and spinal fluid are used to test for any sign of infection, disease or inflammation in the organ systems. Sometimes the lab will order heart and brain tests to monitor electrical activity, known as an EKG and EEG, respectively. (Reference 2)
References
- "Common Chiropractic Conditions Manual;" Nikita Vizniak; 2004
- Diagnosing Brain Disorders
- "AAOS Emergency Care and Transportation of the Sick and Injured 9th edition;" American Academy of Orthopedic Surgeons; 2005
