Intracranial bleed is one of the commonest pathology that can be seen in trauma patient. It can be further divide into mild, moderate and severe which is in other way reflect to GCS itself. It will be mild head injury if the GCS more than 12, mmoderate if the GCS 9-12 and severe if GCS less than 8. It can be suspected if the any of follows happen
- Any period of loss of consciousness (LOC)
- Any loss of memory for events immediately before or after the accident
- Any alteration in mental state at the time of the accident
- Focal neurologic deficits, which may or may not be transient.
I also find that CT head Canadian rules might be help in suspecting ICB as it includes age as 1 of the criteria which diagnosis is a little bit tricky for peadiatric age groups. It includes, GCS dropping post trauma, opened or depressed skull fracture, any signs of basal skull fracture, persistent vomiting or vomiting more than 2, age less than 2 or more than 65. It will be safer to do CT brain for those who are under alcohol or drugs influence for the diagnosis making.
Intracranial bleed can take 2 form which is
Extradural haemorhage, usually related to skull fracture which may tear branches of middle meningeal. Characterize by concave lesion in CT brain and not travel along the sutures
Subdural haematoma, usually related to poor outcome as the brain might be injured together. Characterized by convex lesion and bleed travel along the sutures in the CT brain
