History and physical examination often limited.
If collateral can be obtained, note presence of coagulopathy (e.g. aspirin or coumadin use).
Calculate GCS
Pupils: may identify herniation syndromes
Motor
Focus on symmetry as hemiparesis may suggest herniation syndrome
Elicit movement with noxious stimuli in non-cooperative patients
Note voluntary or purposeful movement (crossing the midline, approaching the stimulus, pushing the examiner's hand away)
Cranial Nerves
Assessable cranial nerves: pupils (III), corneal (V, VII), gag (IX, X), VOR (VII, VI)
Reflexes
Plantar extensor response: non-specific, delineates disruption along corticospinal tract (cortex to LMN)
Focus on symmetry as hemiparesis may suggest herniation syndrome
Elicit movement with noxious stimuli in non-cooperative patients
Note voluntary or purposeful movement (crossing the midline, approaching the stimulus, pushing the examiner's hand away)
Assessable cranial nerves: pupils (III), corneal (V, VII), gag (IX, X), VOR (VII, VI)
Plantar extensor response: non-specific, delineates disruption along corticospinal tract (cortex to LMN)
More common in children than adults
Moderate-to-severe traumatic brain injury
Traumatic brain injury
Mild traumatic brain injury
Intracranial hemorrhage
Ventriculoperitoneal shunt complications
Cerebral edema in brain cancer
Elevated intracranial pressure
Brain herniation syndromes