This haematoma should be removed. CT scan is diagnostic. Intra Cranial Pressure may be helpful. For the head injured patients a neurosurgical consultation must be immediately available. The most important clinical observation to be made in a patient with a head injury is change in the state of consciousness since the injury.
Alteration of consciousness is the hallmark of brain injury.
Prompt and lucid conversation implies alert consciousness. Memory loss for the accident commonly occurs with concussion. Memory loss for such items as address, occupation or year indicates intellectual impairment and represents an early change in consciousness. In progressive stupor leading to coma, lack of a verbal response to questioning occurs sooner than does lack of accurate avoidance of painful stimuli. In coma, there is absence of purposeful movements, either spontaneous or evocated.