1. Symptoms
   1. Immediate
      1. Loss of consciousness
      2. drowsiness
      3. headache
      4. repeated vomiting
   2. After a day
      1. Drowsiness
      2. twitching (left face and arm)
      3. irritability
2. Assessment
   1. Epidural hemorrhage
      1. CT ; biconvex lesion.
      2. 75% are associated with skull fractures. 
      3. Mostly temporal in location
   2. Subdural hemorrhage
      1. CT ; crescentic in shape
   3. Subarachnoid hemorrhage
3. Plan
   1. History taking
   2. P/E
   3. GCS
   4. Imaging
      1. CT scan
         1. Midline shift
         2. Obliteration of the sulci
         3. Blurring of the grey-white junction
   5. Management
      1. Epidural Hematoma
         1. Greater than 30 mL regardless of the patient’s GCS score.
         2. Acute EDH & coma (GCS score ≤8) with pupillary abnormalities.
         3. Less than 30 mL, midline shift less than 5 mm, GCS > 8, No focal deficit
            1. managed nonoperatively : serial CT and close neurologic observation
         4. Surgically evacuated
      2. Subdural Hematoma
         1. (SDH) >10 mm in thickness or associated with midline shift >5 mm
            1. surgically evacuated
      3. Anti-epileptics
         1. In patients with significant structural injury (eg, larger contusions or hematomas, brain laceration, depressed skull fracture) or a GCS score < 10
4. Concussion
   1. Dfn.
      1. traumatic brain injury
   2. S & S
      1. amnesia
      2. ringing ears
      3. delayed response
      4. slurred speech
   3. Grading
      1. American Academy of Neurology (AAN) Guidelines
         1. I
         2. II
         3. III
            1. IIIa
            2. IIIb
   4. Comp.
      1. epilepsy
   5. Tx
      1. Rest
5. Signs
   1. 'eye opening' only to a deep pain stimuli
   2. abnormal respiration
   3. left side lateralization
   4. dilated Rt pupil
   5. GCS scaled 8
      1. Glasgow Coma Scale
         1. Mild
            1. 13-15
         2. Moderate
            1. 9-12
         3. Severe
            1. 3-8
   6. Generalized fits
   7. increased BP (170/110)
6. Anatomy
   1. Brainstem
      1. External features
         1. Ventral
         2. Dorsal
      2. Internal features
   2. Scalp arterial blood supply
      1. Middle meningeal artery
         1. surface marking
7. Demographics
   1. Male, Abdullah Mohammed
   2. 21 yrs old
   3. college student
   4. athletic , footballer
   5. history
      1. frequent traumas