Monitoring
Noncontrast head computed tomography (CT) is usually appropriate for the short-term follow-up imaging of patients with acute head trauma who have unchanged neurologic examination and positive finding(s) on initial imaging such as subdural hematoma (SDH).[35] Magnetic resonance imaging may be indicated as a follow-up study when there are persistent neurologic deficits that remain unexplained after the head CT.[35] A follow-up CT scan is generally recommended 1 to 2 months after discharge from the hospital, but has a marginal impact on reoperation and patient management.[154] 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 neurologic decline.[155] Radiographic imaging should be obtained immediately in the case of new neurologic 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 hematologist. Some data suggest that restarting anticoagulants 1 to 2 weeks after injury, after obtaining a repeat head CT to rule out further acute hemorrhage, may be safe.[156] Further studies are needed in this area.
Use of this content is subject to our disclaimer