Besides the Results of the Glasgow Scale, When Should I Worry?

Seizures and vomiting are always a red flag because they mean a brain edema is developing. There is a very specific type of vomiting called “projectile vomiting” that indicates brain edema and should be treated immediately. It is unavoidable vomiting with great force and without nausea or gagging. Faced with this sign, you should not hesitate to seek help immediately. Traumatic mydriasis, or enlarged pupil size, on physical examination is a reason to be concerned because it means that there is not a good connection from the optic nerve to the eye.

Some of the causes of traumatic mydriasis are cerebral edema, decreased blood flow in that area, and fracture of the skull and face. The patient with this sign should be treated with specialized care that can diagnose and treat the problem. When the patient is unconscious and does not regain consciousness after a severe head trauma, he or she may have suffered a serious condition of neural disconnection called diffuse axonal injury, which is the leading cause of coma in brain trauma patients. The diagnosis of an injury of this magnitude is symptomatic since no neurological damage can be observed in any imaging study. Depending on the type of impact and subsequent symptoms, the diagnostic approach is made. In a patient who has been unconscious for more than 10 minutes, it is imperative to call the emergency department with this diagnosis in mind. Finally, if the patient is awake, always remember to ask them about any symptoms other than the obvious ones, like ears or nose bleeding, loss of muscle strength, tingling, or difficulty mobilizing a limb.

Bin im Garten, Self-photographed, CC BY-SA 3.0