Delayed signs after blunt force head trauma may include which features?

• A. Change in LOC, projectile vomiting, ataxia, unilateral pupil dilation, and seizures
• B. Immediate loss of consciousness followed by full recovery
• C. Scalp tenderness only
• D. Fever and meningismus

Answer: (A)

Delayed signs after blunt head trauma point to evolving intracranial injury and rising pressure from bleeding or swelling. When these signs appear after an initial injury, they signal that a hematoma may be developing or enlarging, leading to brain tissue compression and impaired function.

Change in level of consciousness reflects altered brain activity as pressure increases or tissue is damaged. Projectile vomiting occurs with increased intracranial pressure and brainstem irritation. Ataxia indicates disruption of cerebellar or brainstem pathways, suggesting focal involvement from a hemorrhage or edema. Unilateral pupil dilation means compression of the oculomotor nerve from mass effect, a warning sign of impending herniation. Seizures show cortical irritation from bleeding or contusion, another cue of evolving injury.

In contrast, immediate loss of consciousness followed by full recovery is more typical of a transient concussion rather than delayed deterioration. Scalp tenderness alone suggests a superficial injury without intracranial involvement. Fever and meningismus point to infection or meningeal irritation rather than a delayed intracranial process from blunt trauma.