All that after the injury may not be able to understand the whole, they all can be supported with a thorough medical examination and diagnostic tests. Diagnosis of head injury based on physical examination and diagnostic tests. In the examination, a doctor can get more information from patients or their families and can ask how the injury occurred. Trauma to the head can cause interference neurologist and may be obtained after a medical check-up (Anonymous, 2004).
Diagnostic tests that can be done include:
1. Laboratory examination (Ullman, 2006).
Hematokrit rate, blood chemistry, coagulate factors (including number trombosit) is very important in the assessment of patients with HED, either spontaneously or because of trauma.
Head injury can cause a heavy deliverance tromboplastin network, which it can continue on the occurrence of DIC (Disseminated Intravascular Coagulation). Coagulate previous knowledge about the action required when surgery will be done. If necessary, factors - factors that are associated can be included before the operation & in the operations.
In the adult patients, the occurrence of HED rarely cause a decrease hematokrit a significant degree because the skull bones that have been set. In the baby, where blood volume is still limited, with the epidural bleeding skull bones who ekspansil with the suture still open can lead to loss of blood, which means. Because bleeding can cause instability hemodinamik, so that the necessary degree of monitoring hematokrit regularly and carefully.
2. Vetting radiologist
- Radiography (Ullman, 2006).
skull bones show a picture fracture drift shadow vascular branch of a. meningea media. picture fracture occipital, frontal or vertex is also sometimes found.
There is no guarantee fracture indicate the existence of HED. However, 90% of the cases related to the HED skull bones fracture. In the child - children, the number is smaller because the skull bones deformabilitas greater.
- CT - Scan head (Ullman, 2006).
CT scan method is the most accurate and sensitive in HED diagnose acute. Found a very unique. Space formed by HED layer is limited by dura to the bottom of the tabulation of the skull bones, especially in the suture line, shape description lentikuler or bikonveks. Hidrocephalus sometimes appear in patients with large posterior fossa.
Liquid serebrospinal not mixed with epidural bleeding, where bleeding is more homogeneous and visible dens. Quantity of hemoglobin in the hematoma also determine the number of rays of radiation absorbed.
picture density of hematoma in the brain compared with parenkhim change depending on the time after injury. In the acute phase picture hiperdens (picture bright in CT scan). Then the hematoma became isodens in 2 - 4 weeks, and subsequently became hipodens (dark picture). Many acute bleeding can be seen as a isodens or areas with low density, which shows the possibility of bleeding is in progress or the rate of low serum hemoglobin.
The picture on the air show HED acute fracture in the sinus or the mastoid space cavity.
About 10 - 50% of cases associated with the HED other lesi intrakranial. Lesi include hematoma subdural, contusion cerebral, and hematoma intraserebral.
At the time of surgery or the next otopsi, 20% of patients HED found blood on the epidural and subdural space. (Price, 2006)
- Magnetic resonance Imaging (MRI) (Ullman, 2006).
Acute bleeding in the MRI appears as a isodens, making it less suitable to detect the existence of bleeding due to acute trauma.
- Electroencephalogram (EEG) (Anonymous, 2004).
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