In assessing a traumatic brain injury after a skateboarding accident, which symptom concerns the nurse the most?

In assessing a traumatic brain injury after a skateboarding accident, which symptom concerns the nurse the most?

• A. Asymmetric pupils
• B. Severe headache
• C. Dizziness
• D. Nausea

Answer: (A)

Pupillary asymmetry after a traumatic brain injury is the most concerning sign because it points to possible brain herniation or brainstem compression from an expanding intracranial bleed. When pressure rises on one side, the oculomotor nerve can be disrupted, causing the affected pupil to become enlarged and less responsive to light. This change can progress quickly to deteriorating mental status and life-threatening collapse if not addressed promptly, making it an urgent red flag for immediate assessment and intervention. Severe headache, dizziness, and nausea are important to monitor and can occur with many head injuries, including milder ones, but they are less specific for dangerous brain swelling or herniation. They don’t signal the same imminent risk as a new or worsening asymmetrical pupil.

Pupillary asymmetry after a traumatic brain injury is the most concerning sign because it points to possible brain herniation or brainstem compression from an expanding intracranial bleed. When pressure rises on one side, the oculomotor nerve can be disrupted, causing the affected pupil to become enlarged and less responsive to light. This change can progress quickly to deteriorating mental status and life-threatening collapse if not addressed promptly, making it an urgent red flag for immediate assessment and intervention.

Severe headache, dizziness, and nausea are important to monitor and can occur with many head injuries, including milder ones, but they are less specific for dangerous brain swelling or herniation. They don’t signal the same imminent risk as a new or worsening asymmetrical pupil.