Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXII: Craniocerebral Injury

X-Ray and Laboratory Evaluation

United States Department of Defense

Skull films should be obtained in the AP, right and left lateral views in order to localize fractures and fragments. The presence of an irregular area of increased or overlapped bone density suggests a depressed fracture, and a tangential X-ray should be obtained. Stereoscopic films can help localize intracranial fragments. Lateral shift of the pineal gland if calcified (rare in young individuals) can indicate the presence of an intracranial hematoma. Cervical spine fractures may occur in association with head injury, and cervical spine films should be obtained. The presence of an intracranial hematoma can be visualized by CT scanning, which should be available where definitive neurosurgical treatment is carried out.

Lumbar puncture with a 20 or 22 gauge needle, with 3-5 cc of spinal fluid removed for glucose cells and culture, should be performed if meningitis is suspected after a penetrating wound or after basal fracture with cerebrospinal fluid (CSF) leakage or pneumocephalus.

Frequent measurement of arterial blood gases, serum electrolytes, and osmolality are of great importance in management. 

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Operational Medicine 2001

Health Care in Military Settings

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