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Chapter 17: Head and Acute Cervical Spine Pathologies

Examination of Head Injuries

Examination Map DETERMINATION OF CONSCIOUSNESS

Level of Consciousness

Primary Survey

Secondary Survey

HISTORY

Head pain

Mechanism of Injury

Coup

Contrecoup

Rotational

Repeated subconcussive forces

 Loss of consciousness

 History of concussion

 Preexisting mood disorders

 Emotional impairment

 Weakness/fatigue

 Cognitive impairment

INSPECTION

Inspection of the Bony Structures

Mastoid process

Skull and scalp

Inspection of the Eyes

General

Nystagmus

Pupil size

Pupil reaction to light

Inspection of the Nose and Ears

Fluid escaping

Palpation

Skull

FUNCTIONAL ASSESSMENT

Cranial Nerve Assessment

Neurocognitive Function

Behavior

Analytical skills

Information processing

Memory

SCAT3

Balance and Coordination

Romberg test

Tandem walking test

Modified Balance Error Scoring System

Vital Signs

Respiration

Pulse

Blood pressure

Pulse pressure

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUES TESTS

Traumatic Brain Injury

Concussion

Postconcussion Syndrome

Diffuse Cerebral Swelling

Intracranial Hemorrhage

 Epidural hematoma

 Subdural hematoma

Skull Fractures

 Halo Test

Determination of Consciousness

FIGURE 17-1

Establishing the presence of consciousness. (A) If the athlete is unconscious and prone, (B) roll to the supine position and determine an open airway, breathing, and circulation.

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Inspection

FIGURE 17-2

Anisocoria, or unequal pupil size. Note the increased diameter of the patient's right pupil. This condition may result from pressure on the oculomotor nerve (cranial nerve III) or may be congenital.

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FIGURE 17-3

Ecchymosis over the mastoid process, Battle's sign, may suggest a skull fracture.

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Functional Assessment

Table 17-1Cranial Nerve Function
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Table 17-1 Cranial Nerve Function
Number Name Type Function
I Olfactory Sensory Smell
II Optic Sensory Vision
III Oculomotor Motor

Regulates pupillary reaction and size

Elevation of upper eyelid

Eye adduction and downward rolling
IV Trochlear Motor Upward eye rolling
V Trigeminal Mixed

Motor: Muscles of mastication

Sensation: Nose, forehead, temple, scalp, lips, tongue, and lower jaw
VI Abducens Motor Lateral eye movement
VII Facial Mixed

Motor: Muscles of expression

Sensory: Taste
VIII Vestibulocochlear Sensory

Equilibrium

Hearing
IX Glossopharyngeal Mixed

Motor: Pharyngeal muscles

Sensory: Taste
X Vagus Mixed

Motor: Muscles of pharynx and larynx

Sensory: Gag reflex
XI Accessory Motor Trapezius and sternocleidomastoid muscles
XII Hypoglossal Motor Tongue movement
Clinical Application
Function Cranial Nerves How Tested
Eye Assessment II, III, IV, VI Visual acuity, pupillary reaction, and tracking
Balance VIII Romberg test, Balance Error Scoring System (BESS)
Speaking/Hearing VIII, IX, X, XII Speaking to the patient; the patient speaking
Facial Expression V, VII, XII Smile, frown, stick out tongue
Smelling I Based on self-reported symptoms (often a "bad smell")
Shoulder Shrug XI Resist shoulder girdle raise

Neurocognitive Function

FIGURE 17-4

Types of amnesia. Retrograde amnesia is the loss of memory from the onset of injury backward in ...

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