Is a CT Scan Necessary After a Head Injury? the Risks

Is there a necessity for a non-contrast CT scan of the brain?

Hello Dr.
Ding,
My brother weighs about 100 kilograms and fell off his bike on a rainy, slippery road.
He has a head injury with an external wound measuring approximately 7 to 10 centimeters.
When bystanders brought him to the surgical clinic, he was unaware of the accident and did not know how he got there.
The external injury has been treated, and he has undergone X-rays, which showed no fractures.
He has since left the clinic and is currently alert, but there is significant bleeding in his mouth (though his lips are uninjured).
He has also been reporting numbness and pain in his upper limbs.
Given these injuries and the fall, is there a high likelihood of intracranial hemorrhage? Is it necessary to send him to the emergency department immediately for a CT scan of the brain? Additionally, I recently read a Q&A stating that falls could potentially cause cervical spine injuries.
Would a CT scan be required to detect such injuries?
Thank you.

A Da, 30~39 year old female. Ask Date: 2012/06/24

Dr. Ding Xianwei reply Neurosurgery

If it is an emergency issue, you should go directly to the emergency department for evaluation and treatment by an emergency physician.
Since I cannot examine you in person, I can only provide suggestions based on your description.
It sounds like you may have experienced a concussion, especially since you lost consciousness and memory following a head injury.
A concussion requires adequate rest and hydration.
However, there is a risk of delayed bleeding, so it is essential to monitor your condition for at least a month.
Regarding the numbness and pain in both upper limbs, I suspect you may have a cervical spine injury.
However, the current examinations may not provide useful information for treatment.
The most important step now is to wear a cervical collar and wait about two to three months before performing X-rays to receive appropriate recommendations.
If you are experiencing quadriplegia, hospitalization for further management is necessary.
The purpose of examinations is to assist in treatment; the examinations themselves do not contribute directly to treatment.
If a cervical spine injury is suspected, an MRI may be needed to assess changes within the spinal cord.
It is recommended to wear the cervical collar continuously, 24 hours a day.

Reply Date: 2012/06/24

More Info

After a head injury, especially one accompanied by significant external trauma and symptoms such as confusion, bleeding, or persistent pain, a CT scan is often necessary to rule out serious complications like intracranial hemorrhage (bleeding within the skull) or other traumatic brain injuries. In your brother's case, given the details you've provided—specifically the size of the external injury, his altered state of consciousness, and the presence of blood in his mouth—there are several important considerations to keep in mind.

Risks of Intracranial Hemorrhage
Intracranial hemorrhage can occur even if there are no visible signs of injury on the surface of the head. The mechanism of injury, such as a fall or collision, can cause the brain to move within the skull, potentially leading to tears in blood vessels. Symptoms of intracranial bleeding may not appear immediately and can develop over hours or even days. Common signs to watch for include:
- Persistent or worsening headache
- Nausea or vomiting
- Confusion or altered mental status
- Weakness or numbness in limbs
- Seizures
Given that your brother is experiencing upper limb numbness and pain, this could indicate potential neurological involvement, which warrants immediate medical evaluation.

Importance of CT Scans
A CT scan is a critical diagnostic tool in these scenarios. It can quickly identify bleeding, swelling, or other abnormalities in the brain. In cases where there is a significant mechanism of injury, such as a motorcycle accident, the risk of serious injury is heightened, and a CT scan can provide peace of mind or prompt necessary interventions.

Cervical Spine Considerations
Regarding the potential for cervical spine injury, it is indeed possible for neck injuries to occur alongside head trauma, especially in cases of falls or collisions. Symptoms such as upper limb numbness could suggest nerve involvement, which may stem from cervical spine issues. A CT scan or MRI of the cervical spine may be necessary if there are concerns about vertebral fractures or spinal cord injury.

Recommendations
1. Immediate Medical Attention: Given your brother's symptoms and the mechanism of injury, it is advisable to seek immediate medical attention. A CT scan of the head should be performed to rule out any intracranial bleeding or other complications.

2. Neurological Assessment: A thorough neurological examination should be conducted to assess his cognitive function and motor skills. This will help determine if there are any deficits that need to be addressed.

3. Monitoring Symptoms: If he is discharged from the hospital, it is crucial to monitor his symptoms closely. Any worsening of his condition should prompt a return to the emergency department.

4. Follow-Up Imaging: If there are ongoing concerns about cervical spine injury, follow-up imaging may be warranted based on his symptoms and the initial assessment.

In conclusion, while not every head injury requires a CT scan, the combination of your brother's symptoms and the nature of his injury strongly suggests that further evaluation is necessary. It is always better to err on the side of caution when it comes to head injuries, as timely intervention can significantly impact outcomes.

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