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Last reviewed: 19 Sep 2025
Last updated: 15 Oct 2025

Summary

Definition

History and exam

Key diagnostic factors

  • evidence or history of trauma
  • focal neurologic deficit
  • headache
  • signs of elevated intracranial pressure (ICP)
  • abnormal pupillary reflexes

Other diagnostic factors

  • loss of consciousness/decreased alertness
  • cognition changes
  • dysphasia
  • seizure
  • loss of bowel and bladder continence
  • localized weakness
  • sensory changes
  • otorrhea
  • rhinorrhea

Risk factors

  • recent trauma
  • coagulopathy and anticoagulant use
  • advanced age (>65 years)
  • excessive alcohol use
  • intracranial hypotension (e.g., secondary to cerebral shunt or cerebrospinal fluid [CSF] leak)

Diagnostic tests

Treatment algorithm

Contributors

Authors

Christopher P. Robinson, DO, MS

Associate Professor of Neurology and Neurosurgery

Division of Neurocritical Care

Vice Chair of Clinical Operations

Neurology Clerkship Director

University of Florida College of Medicine

Florida

FL

Disclosures

CPR has received compensation for serving as an expert witness.

Acknowledgements

Dr Christopher P. Robinson would like to gratefully acknowledge Dr Andrew W. Grande, Dr Stephen J. Haines, Dr Praveen R. Baimeedi, Dr Jason S. Hauptma, and Dr Neil A. Martin, previous contributors to this topic.

Disclosures

AWG, SJH, PRB, JSH, and NAM declare that they have no competing interests.

Peer reviewers

Nathan J. Ranalli, MD

Resident

Department of Neurosurgery

University of Pennsylvania School of Medicine

Philadelphia

PA

Disclosures

NJR declares that he has no competing interests.

Marek Ma, MD

Instructor

Emergency Medicine

Department of Emergency Medicine Administrative Offices

University of Pennsylvania

Philadelphia

PA

Disclosures

MM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Expert Panel on Neurological Imaging; Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® head trauma: 2021 update. J Am Coll Radiol. 2021 May;18(5S):S13-36.Full text  Abstract

American College of Surgeons. Best practice guidelines: the management of traumatic brain injury. 2024 [internet publication].Full text

Carney N, Totten AM, O'Reilly C, et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80(1):6-15.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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