The evaluation of a head injury begins with a history and physical exam.

Physical findings in someone with a head injury may include:

• Blood behind the eardrum:
• Hearing loss
• May be a sign of basilar skull fracture
• Bruising behind the ear or around both eyes:
• May be a sign of basilar skull fracture
• Clear cerebrospinal fluid leaking from the nose:
• A sign of basilar skull fracture
• Large scalp contusion
• Neck tenderness
• Skull deformity:
• A depressed area on the skull (depressed skull fracture)
• Visible skull fracture through a scalp wound

Additional findings on a neurologic exam may include:

• Abnormal eye muscle exam
• Abnormal eye pupil exam
• Amnesia
• Confusion
• Difficulty speaking
• Difficulty walking
• Numbness in one arm or leg:
• Arm numbness (unilateral)
• Leg numbness (unilateral)
• Arm and leg numbness (unilateral)
• Weakness in one arm or leg:
• Arm weakness (unilateral)
• Leg weakness (unilateral)
• Arm and leg weakness (unilateral)
• Loss of consciousness
• Papilledema:
• Evidence of increased brain pressure on eye exam
• Seizure

Tests may be necessary to determine the extent of the head injury.

Tests that may be used to evaluate head injury include:

• Skull x-rays
• CT scan of the brain
• MRI scan of the brain
• X-rays of the neck:
• Normal cervical spine
• Torn ligaments
• Fracture of the odontoid process of the second vertebra
• Fracture of a vertebral body
• Fracture of a spinous process in the back of a neck vertebra