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Diagnosis of craniocerebral trauma
Medical expert of the article
Last reviewed: 04.07.2025
First, it is necessary to assess the damage as a whole; diagnosis and treatment of seriously ill patients are carried out simultaneously.
A rapid and focused neurologic examination is part of the general assessment. It should include assessment of the level of consciousness using the GCS, upper airway and breathing, and oculomotor activity. Ideally, the examination should be performed before the administration of muscle relaxants and opioid analgesics. The patient is re-examined at frequent intervals (eg, every 15 to 30 minutes initially, then every hour after stabilization). Subsequent improvement or worsening helps determine the severity of the injury and prognosis. A complete neurologic examination is performed immediately after the patient has stabilized. Children are carefully examined for retinal hemorrhages, which may indicate shaken baby syndrome. Fundoscopy of the eye is diagnostically insensitive and difficult to perform in adults with traumatic brain injury.
The diagnosis of concussion is made clinically, but imaging may help detect more significant brain injury and identify hematomas. Imaging is mandatory for all patients with altered consciousness, GCS <15, focal neurologic symptoms, recurrent vomiting, seizures, or clinical suspicion of fractures. However, many clinicians perform CT in all patients, even after minor head injuries, because the clinical and medico-legal consequences of an undetected hematoma are severe.
CT is the best initial imaging choice. It can detect skull fractures (thin sections are used to detect clinically suspected basal skull fractures that are not visible with other imaging modalities), hematomas, contusions, and occasionally diffuse axonal injury. Although plain radiography can detect some skull fractures, it does not evaluate brain tissue changes and is rarely used. MRI may be helpful later in the disease course in detecting smaller contusions and diffuse axonal injury; MRI is generally more sensitive than CT for detecting small acute, subacute, and chronic subdural hematomas. Arteriography is used in some cases when vascular injury is suspected or when CT findings are inconsistent with clinical examination.
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