Which is a sign of head injury?

• A. No changes in consciousness
• B. Obvious scalp, skull wound or deformity
• C. Normal pupil reaction
• D. Only neck tenderness

Answer: (C)

In assessing possible head injury, the clearest indicator is direct trauma to the head that you can see or feel. An obvious scalp, skull wound, or deformity is a definite sign that the head has been injured and needs careful monitoring and protection of the airway, breathing, and spine as needed. Changes in consciousness are important, but their absence doesn’t rule out head injury, and neck tenderness suggests potential cervical spine injury rather than a head injury itself. Pupil reaction is a neurological sign; abnormal pupil responses (unequal or nonreactive) raise concern for brain injury, while a normal reaction is not itself a sign of injury. So, among the options, the most definitive sign of head injury is an obvious scalp, skull wound, or deformity.