Trauma is the fifth leading cause of death in industrial nations, following heart disease, cancer, stroke, and chronic respiratory disease. The likelihood of fatality resulting from trauma triples if severe head injury (cranio-cerebral injury) is involved. In other words, severe head trauma is the key factor in prognosis.

Craniocerebral trauma is defined as injury to the neurocranium, which includes soft tissues, bones of the cranial vault (calotte), hard and soft cerebral membranes, and the cerebellum and cerebrum. The extent of injury to soft tissues, cranial bones, and brain tissue varies.

Closed head injury describes trauma in which the dura mater remains intact.

If the dura mater is injured, this is considered an open head injury. Cerebrospinal fluid leakage from the nose or ear is a sign of dura injury at the skull base.

Open head injury involves a communication between the exterior and the interior of the cranium, i. e., the brain. One can distinguish between:

a directly open head injury with opening of the skin and with underlying fracture and dura mater injury and;

an indirectly open head injury associated with fracture of an air-filled cavity—e. g., the frontal sinus.

The occurrence of an open head injury is not predictive of further prognosis. It is crucial that an open head injury is transformed into a closed head injury as quickly as possible. The following procedures must be performed:

debridement of the soft tissue wound;

elevation of depressed fracture, if present;

removal of bone splinters;

removal of injured and devitalized brain tissue;

watertight dural closure and;

closure of subcutaneous and cutaneous layers.

Regardless of whether the injury involves open or closed head injury, the patient must undergo a brief clinical neurologic assessment as well as a computed tomography scan (CT) as soon as possible.

Clinical classification of head trauma is based on the severity of impaired consciousness, as measured by the Glasgow Coma Scale (GCS). Computed tomography findings offer another possibility for classification (Marshall classification).

Clinical evaluation prior to diagnostic imaging includes:

inspection of the head region, search for ecchymosis, arterial hemorrhage, galea hematomas, cerebrospinal fluid leakage, extruding brain tissue;

targeted questioning of the patient, testing for adequate responses, spatial and temporal orientation, verbal abilities;

test of level of consciousness; by definition, a patient is comatose, i. e., unconscious, if he does not open his eyes in response to pain;

test of pupillary response and extraocular movement; pupil size, reaction to light, anisocoria, corneal reflex.