Diagnosing Head Trauma

Depending on the injuries, a variety of tests are needed to diagnose head trauma

Head trauma can injure many organs and structures. The brain, facial bones, eye sockets, eyes, ears, facial nerves, sinuses, nose, mouth and breathing pathways may all be traumatized.

Diagnosing what has been injured requires a variety of tests. These tests sometimes need to be repeated during and after treatment, to track the healing process.

One of the most important guides to ordering the right diagnostic tests is the baseline medical history of the injury.

How the injury happened, any associated injuries, if there was loss of consciousness and if so for how long, and all other relevant information is needed.

Glascow Coma Scale

The first assessment performed after a head injury is determining the Glascow Coma Scale (GCS). GCS measures a person’s response to a variety of commands including speaking, opening the eyes, and moving.

This is a very important diagnostic test because it provides a baseline level of function. Any changes to a person’s GCS will immediately alert care providers that the brain is either improving or worsening.

The highest a person can score on a GCS test is 15, and the lowest one can score is a 3.

A score between 13 and 15 means that the head trauma resulted in a mild traumatic brain injury (TBI). A score of 9-12 is considered a moderate TBI and anything 8 or below is considered severe.

Imaging tests

Radiologic tests are ordered to determine the extent of bony and soft tissue damage throughout the head.

X-Ray: X-rays can identify fractures, structures that are out of place and some foreign bodies such as bullets.  Since X-rays do not provide detailed information, they have been largely replaced by the use of head CTs in the acute setting.

Ct Scan: A Computed Tomography scan is used to find bleeding inside the brain.

It can also identify bone fractures and some soft tissue damage throughout the head and face. CT scans provide more detailed images than x-rays.

MRI: Magnetic Resonance Imaging is used to get a very detailed picture of bones, nerves, blood vessels and tissues of the brain, face and head. An MRI is usually delayed until the patient is stabilized, broken bones put back into place, and bleeding stopped.

Intra-Cranial Pressure (ICP) Monitoring

In order for the brain to receive adequate blood flow and oxygen, the pressure inside the skull needs to be maintained at a safe level. If the brain has been traumatized during the head injury, bleeding and swelling quickly cause pressure inside the brain to go up.

A probe to measure pressure inside the head (ICP) and a drain called a shunt, may be placed during surgery. This allows blood and fluid to be drained when pressure inside the head gets too high.

Eye Tests

An ophthalmologist performs an eye exam to determine eye pressure, damage to the globe of the eye, and see if there is bleeding inside the eye. Bleeding into the eye and increased eye pressure are medical emergencies, because they can lead to permanent blindness.

Regular eye exams are needed after head trauma that damages structures of the eye.

Traumatic eye injury increases the risk of glaucoma.

Neurologic and Cognitive Tests

Many symptoms of head and brain trauma are subjective, meaning they can’t be seen on an x-ray or MRI, but are still very real to the head trauma victim.

Neuro-psychologic testing evaluates how an individual reacts to the environment and to specific tasks. When the medical team knows how the brain is responding at baseline, it helps them decide what types of rehabilitative therapies are best for each person.

The testing evaluates: expression, reasoning, problem solving, organization, concentration, social judgment, memory, attention span and ability to learn and retain new information.

Psychological and emotional health are also evaluated.

These are just a few of the key diagnostic tests used for head trauma. Depending on unique injuries and circumstances, there are many tests that may be ordered at different points after injury and during recovery.


Brenner, L, (2011) Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder; Dialogues Clin Neurosci. (3): 311–323.

Tien HC, Cunha JR, Wu SN, Chughtai T, Tremblay LN, Brenneman FD, Rizoli SB. (2006) Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? J Trauma;.60(2):274-8.

Van Boven RW, Harrington GS, Hackney DB, Ebel A, Gauger G, Bremner JD, D'Esposito M, Detre JA, Haacke EM, Jack CR Jr, Jagust WJ, Le Bihan D, Mathis CA, Mueller S, Mukherjee P, Schuff N, Chen A, Weiner MW. (2009) Advances in neuroimaging of traumatic brain injury and posttraumatic stress disorder. J Rehabil Res Dev. 46(6):717-57.

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