Traumatic brain injury physical examination: Difference between revisions

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Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination with trauma survey of the whole body and most importantly neurologic examination. The neurologic exam of a traumatic brain injury patient includes the following key components.  
Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination with trauma survey of the whole body and most importantly neurologic examination. The neurologic exam of a traumatic brain injury patient includes the following key components.  


*Level of [[Consciousness|consciousness]],
*Level of [[Consciousness|consciousness]]/[[Glasgow Coma Scale|Glasgow Coma Scale (GCS)]]
*[[Glasgow Coma Scale|Glasgow Coma Scale (GCS)]]
*[[Frontal lobe|Higher]] function
*[[Cranial nerve examination]]
*[[Cranial nerve examination]]
*[[Motor Control|Motor examination]]
*[[Motor Control|Motor examination]]
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General examination with trauma survey includes assessment of injuries else where, including contusions, fractures, dislocations, and/or soft tissue injuries.   
General examination with trauma survey includes assessment of injuries else where, including contusions, fractures, dislocations, and/or soft tissue injuries.   


Neurologic examination is obviously the most important part of physical examination. Level of consciousness, as assessed by [[Glasgow coma scale|GCS]] is considered to be the best predictor of the prognosis in the acute traumatic brain injury. The components of [[Glasgow coma scale|GCS]] include assessment of best verbal, eye and motor response, followed by scoring. The minimum score is 3 and the maximum score is 15.
Neurologic examination is obviously the most important part of physical examination. Level of consciousness, as assessed by [[Glasgow coma scale|GCS]] is considered to be the best predictor of the prognosis in the acute traumatic brain injury. The components of [[Glasgow coma scale|GCS]] include assessment of best verbal, eye and motor response, followed by scoring. The minimum score is 3 and the maximum score is 15. A GCS of score 3 to 8 represents severe TBI, scores 9 to 12 represents moderate TBI and scores 13 to 15 represents mild TBI. 


Common physical examination findings of traumatic brain injury include<ref name="pmid29083790">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages= | pmid=29083790 | doi= | pmc= | url= }} </ref>
The examination of cranial nerves, sensory system, motor system and co-ordination is important to find any focal neurological deficit, as that might indicate injury or sometimes can signify brain herniation. Examples of focal neurological deficit are:  


*Signs of physical trauma to the skull.
* Irregular pupils or Unresponsive pupils, ptosis, impaired extraocular movements 
*[[Neurological examination|Neurologic deficit]]
* Other cranial nerve deficits 
**[[Motor coordination|Motor]] and sensory skills
* Focal gross motor weakness 
**[[Hearing]] and [[speech]]
* Focal numbness 
**[[Motor coordination|Coordination]] and [[Balance disorder|balance]]
* Co-ordination deficits 
**[[Mental status examination|Mental status]]
* Gait imbalances 
**[[Mood]] or [[behavior]] changes


==References==
==References==

Revision as of 19:49, 27 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Joanna Ekabua, M.D. [2]

Overview

Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination with trauma survey of the whole body and most importantly neurologic examination. The neurologic exam of a traumatic brain injury patient includes the following key components.

Physical Exams

Measuring vital signs is the first thing to do. A wide pulse pressure in the setting of a new onset bradycardia and bradypnea could mean elevated intracranial pressure. Cushing's reflex is a physiological response to an acute increase in intracranial pressure, leading to a triad of widened pulse pressure, bradycardia and irregular respirations.

General examination with trauma survey includes assessment of injuries else where, including contusions, fractures, dislocations, and/or soft tissue injuries.

Neurologic examination is obviously the most important part of physical examination. Level of consciousness, as assessed by GCS is considered to be the best predictor of the prognosis in the acute traumatic brain injury. The components of GCS include assessment of best verbal, eye and motor response, followed by scoring. The minimum score is 3 and the maximum score is 15. A GCS of score 3 to 8 represents severe TBI, scores 9 to 12 represents moderate TBI and scores 13 to 15 represents mild TBI.

The examination of cranial nerves, sensory system, motor system and co-ordination is important to find any focal neurological deficit, as that might indicate injury or sometimes can signify brain herniation. Examples of focal neurological deficit are:

  • Irregular pupils or Unresponsive pupils, ptosis, impaired extraocular movements
  • Other cranial nerve deficits
  • Focal gross motor weakness
  • Focal numbness
  • Co-ordination deficits
  • Gait imbalances

References


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