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Usually, traumatic brain injuries are emergencies and the person is directly brought into the emergency department of the hospital. In the emergency room, a quick history about the injury and mode of injury is taken, followed by physical and neurological examination especially using the Glasgow coma scale (GCS) to assess the severity of the brain injury and to determine the expected course of the disease.
The GCS gives scoring by assessing three findings during neurological examination:
1. Eye-opening (E): 4 for spontaneous eye-opening, 3 for eye-opening to voice, 2 for eye-opening on induction of pain, 1 for none.
2. Verbal Response (V): 5 for normal conversation, 4 for oriented conversation, 3 for words, but with no coherence, 2 given for ability to produce sounds with loss of ability to form words, 1 for none.
3. Motor Response (M): 6 for normal, 5 for localized to pain, 4 for withdrawal to
pain, 3 for decorticate posture, 2 for decerebrate posture.
The traumatic brain injury is classified according to GCS as follows:
1. Mild: when the GCS is between 13 to 15.
2. Moderate: when the GCS is between 8 to 12.
3. Severe: when the GCS is below 8.
Further, it is followed by imaging tests which help as follows:
To determine the type of head injury
To help in complementing the clinical findings and severity of the injury
To determine the expected disease course and guide treatment
Following are the imaging tests done in case of TBI:
Computerized tomography (CT) scan: this is a primary test performed in all patients suspected of TBI. The test uses X-rays to produce images of the brain and bones and to detect any injury such as contusion, hemorrhage, hematoma, swelling, and skull fractures. It may not be able to detect all cases of diffuse axonal injury which can be detected by MRI.
Magnetic resonance imaging (MRI): this test may be done in some cases where some additional information is needed or clinical suspicion doesn’t match with CT findings. The MRI may detect some subtle findings not seen on CT. MRI can detect DAI not seen on CT and is indicated in cases where CT finding doesn’t correspond to the findings of clinical examination.
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