Monitoring
Non-contrast head computed tomography (CT) is usually appropriate for the short-term follow-up imaging of patients with acute head trauma who have unchanged neurological examination and positive finding(s) on initial imaging such as subdural haematoma (SDH).[35] Magnetic resonance imaging may be indicated as a follow-up study when there are persistent neurological deficits that remain unexplained after the head CT.[35] A follow-up CT scan is generally recommended 1 to 2 months after discharge from hospital, but has a marginal impact on re-operation and patient management.[153] Routine follow-up scans in patients with a Glasgow Coma Scale score of 13 to 15 are unlikely to show progression requiring intervention in the absence of progressive neurological decline.[154] Radiographic imaging should be obtained immediately in the case of new neurological symptoms, headache, nausea, vomiting, or dizziness. Neurosurgical follow-up is essential.
Decisions regarding the timing of the restarting of anticoagulants after injury should be made in consultation with a neurointensivist, cardiologist, and haematologist. Some data suggest that restarting anticoagulants 1 to 2 weeks after injury, after obtaining a repeat head CT to rule out further acute haemorrhage, may be safe.[155] Further studies are needed in this area.
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