Craniocerebral Trauma
Summary of last class Pathogenesis; Pathology; Classification; Radiographic Evaluation
Clinical Findings
Symptoms and Signs Initial examination（首先评估情况） initial general trauma assessment: ABCs (airway, breathing, and circulation). initial trauma neurologic examination: ABCDs (D is for disability)
Glasgow Coma Scale (GCS) Coma: GCS<=8 Severe injury: GCS<=8 Moderate injury: GCS 9-12 Mild injury: GCS: 13-15
Cranial nerve and reflex assessments Depend on patient’s level of consciousness. Awake（清醒检查） Cmoa（昏迷检查） Three reflexes: the pupillary reflex; the corneal reflex; the gag reflex
Continue. The pupillary reflex: information via cranial nerve Ⅱ(optic nerve), and nerve Ⅲ (oculomoter). Localizing in the midbrain. A unilaterally dilated or fixed pupil in the comatose patient is of considerable concern as it often indicates transtentorial herniation of the ipsilateral hypertension
Continue. The corneal reflex: information via cranial nerve Ⅴ (ophthamic portion of trigeminal nerve), and nerve Ⅶ (facial). Localizing in the pons. The loss of the corneal often indicates severe brain stem injury
Continue. The gag reflex: afferent and efferent signals are carried via the glossopharyngeal (Ⅸ) and vagus (Ⅹ) nerves. Localizing in medulla. The loss of gag reflex indicates severe brain stem injury
Assessment of motor function Motor Scoring System Grade Description 0 No muscle contraction 1 Visible muscle contraction without movement across the joint 2 Movement in the horizontal plane, unable to overcome gravity 3 Movement against gravity 4 Movement against some resistance 5 Normal strength