Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Head Trauma Hearing Loss 663

tests

■CT scan of head and neck: may reveal intracranial hemorrhage, cere-

bral edema, cervical fracture-dislocation

differential diagnosis

N/A

management

■Maintain airway; support vital functions

■Specific therapy as suggested by clinical & CT scan assessment of

severity of head injury

specific therapy

■If no LOC, no neurologic abnormality & normal CT scan, pt can

go home w/ supervising adult to check level of arousal & pupillary

responses periodically for 24 hrs

■If LOC for >5 min, focal deficit, obtundation, signs of increased ICP

or skull fracture present, observe in hospital even if no hematoma

present on CT scan

■If CT scan shows small subdural or intracerebral hematoma, observe

in hospital

■If CT scan shows large subdural hematoma, evacuate surgically

follow-up

N/A

complications and prognosis

■Subarachnoid hemorrhage: no specific action needed

■Acute hydrocephalus: consider shunt

■Subdural hygroma: may require evacuation

■CSF leak: close surgically if persists or leads to meningitis

■Post-traumatic seizure disorder (beyond 1st week): anticonvulsants

■Postconcussion syndrome of headache, personality change, poor

attention span, dysequilibrium, visual disturbances: antidepressant

medication; typically settles spontaneously after weeks or months

Hearing Loss........................................

ANIL K. LALWANI, MD

history & physical

History

Conductive hearing loss (CHL)

■Usually due to pathology in the external or middle ear