In a patient after a minor head injury, which diagnostic test is most helpful to assess for intracranial injury and skull fractures?

• A. Head CT scan
• B. Lumbar puncture
• C. Skull radiographs
• D. Electroencephalogram

Answer: (A)

Imaging after minor head trauma is driven by the need to quickly identify bleeding inside the skull and any skull fractures. A CT scan of the head without contrast is the test that best serves this goal because it rapidly reveals acute intracranial hemorrhage, contusions, edema, and bone injuries. This information directly guides next steps, such as observation, hospital admission, neurosurgical consultation, or intervention.

Lumbar puncture won’t reveal an acute bleed and can be dangerous if there’s raised intracranial pressure or a mass effect, so it isn’t helpful in this acute setting. Skull radiographs miss subtle fractures and do not reliably detect intracranial injuries. An EEG measures brain electrical activity rather than structural injury and is used for seizure evaluation, not imaging after head trauma.

So, the head CT scan is the most informative and appropriate initial test after minor head injury to assess for intracranial injury and skull fractures.