View source for Traumatic brain injury physical examination

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{{Traumatic brain injury}}

{{CMG}} {{JE}}
==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. 

*Level of [[Consciousness|consciousness]]/[[Glasgow Coma Scale|Glasgow Coma Scale (GCS)]]
*[[Cranial nerve examination]]
*[[Motor Control|Motor examination]]
*[[Sensory Neuroscience|Sensory]] examination
*Examination of [[Cerebellum|cerebellar]] function and [[Gait (human)|gait]]

==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 triad|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 [[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.   

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==
{{reflist|2}}
[[Category:Neurotrauma]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Needs content]]

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