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Client Library Article
HEAD TRAUMA
| About Head Trauma |
| Pets commonly suffer various
degrees of head trauma after being hit by a car or suffering other traumatic
injury such as a high fall, getting kicked, or being struck by a bat etc. Trauma to the
head can cause skull fractures, crushed sinuses, jaw fractures, bleeding
within the brain (hematoma formation), brain contusions (bruising),
seizures, concussions, and worst of all herniation of the brain due to high
pressures within the skull. The degree
of head trauma is assessed by examining reflexes involving the cranial nerves
(nerves supplying the sensory organs and facial muscles), pupils, and
mental alertness. Many veterinarians find treating head trauma
frustrating for it is hard to predict how the pet will do and often veterinarians have to take a “wait and
see” type of approach when treating for head trauma. Some pets recover rapidly
with supportive care, while others can take several days to weeks to fully
recover. Occasionally patients signs decline rapidly and the animal
dies suddenly. Each animal is different and both doctors and owners
must be patient. |
| Symptoms |
- Unequal pupil size- constricts with light (good prognosis)
- Fixed pinpoint size pupils (guarded prognosis)
- Fixed dilated pupils (grave prognosis)
- Constant repetitive rapid eye movement (nystagmus)- up and down or
side to side
- Bleeding from nostril(s) (epistaxis)
- Mental dullness / unaware
- Labored / frantic breathing
- Seizures
- Coma
- Sudden death- usually with brain herniation
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| Diagnosis |
- Physical exam and neurologic assessment of the cranial nerves. The
patient is assessed several times a day to look for either an improvement or decline in neurologic function. Veterinarians try to identify a
trend over several
days to help owners decide whether to continue treatment or euthanize the
patient. Head trauma often takes several days to weeks, sometimes even months to
resolve. Some pets never recover fully, however, most times dogs adapt
easily to the neurologic impairment.
- Radiographs can be taken to look for skull, sinus, and jaw
fractures. The majority of dogs however have primarily brain injury
which does not show up on films.
- MRI and CAT scan- advanced imaging techniques to assess the
brain. These can show blood clots, bruises, brain bleeding, depressed
skull fractures, and a number of other trauma related lesions.
- Additional
diagnostics such as blood work, chest and abdominal, and skeletal
radiographs, blood gasses, etc are used to assess / identify injury to the
rest of the body.
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| Treatment- Supportive
Care |
| Treatment is based on supportive care and stabilizing the
patient who commonly presents with other bodily injuries. Head trauma is
treated with a variety of drugs including steroids, mannitol (a drug used to decrease brain inflammation and swelling),
supplemental oxygen., antibiotics (if bleeding from the nose is present,
and other anti-inflammatory medications. Injury to other body systems is
addressed as well as shock. Treatment should be continued for at least 48
hours unless the animal shows signs of severe trauma or declining clinical
status that carries a grave
prognosis for survival (ie coma, fixed dilated pupils). |
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Prognosis
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Depends entirely of the form and extent of the head
trauma. Animals in a coma, or who present with repetitive
seizures or breathing difficulty carry a grave prognosis as well as pets
with fixed dilated pupils. Patients with fixed non-responsive pin point size
pupils or fixed pupils of two different sizes carry a guarded prognosis.
Treatment should be attempted for all animals with unequal size pupils that
respond to light by constricting. These patients carry a good prognosis for
recovery with proper treatment along with sinus injuries and jaw fractures.
As long as the animal is not in pain or compromised by severe injuries to
the rest of the body, one should always try medical therapy for at least 48
hours. Many pets respond dramatically.
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