A fall, especially one involving a strike to the head, creates a risk that extends beyond immediate visible injuries. The primary concern is the potential for delayed complications, such as a slow bleed or swelling inside the skull, which can take hours or even days to manifest. A neurological check, or “neuro check,” is a standardized assessment of brain function used to detect subtle changes that signal a worsening condition. This guidance is for informational purposes only; medical decisions after a fall should be made in consultation with a qualified healthcare professional.
Immediate Emergency Indicators
Certain symptoms that appear immediately after a fall or develop shortly after require an immediate call for emergency medical services. These signs indicate a potentially severe and rapidly progressing brain injury that cannot be monitored safely at home.
Immediate emergency indicators include:
- Any loss of consciousness, even if brief.
- A severe or rapidly worsening headache.
- Repeated vomiting (more than once after the initial event).
- Seizure activity or new weakness/numbness affecting one side of the body (focal neurological deficit).
- Slurred speech, inability to wake the person up, or profound confusion.
- Difficulty recognizing familiar people or places, or inability to follow simple commands.
Such symptoms require immediate transfer to an emergency department for advanced imaging and care.
Key Components of the Neurological Assessment
The neurological assessment is a structured method for evaluating specific aspects of brain function, allowing for a comparison against a baseline state. This check focuses on three main areas: level of consciousness, pupillary reaction, and motor function.
Level of Consciousness
The level of consciousness and orientation is often assessed using standardized tools like the Glasgow Coma Scale (GCS). Caregivers can use simpler questions to determine if the person is awake, alert, and oriented to person, place, and time. Any change in the ability to answer these questions or a decrease in overall responsiveness is a cause for concern.
Pupillary Reaction
Checking the pupils involves observing their size, shape, and reaction to light. Both pupils should be equal in size and constrict quickly and equally when a light is shined into them. If one pupil is significantly larger than the other, or if one or both do not react to light, it can signal pressure on the brain.
Motor Function
Motor and sensory function is checked by assessing strength and movement in the arms and legs. This includes checking the person’s hand grip strength on both sides for equality. The person should be able to move all four extremities equally and report normal sensation, without any new tingling, numbness, or weakness.
Recommended Monitoring Timelines
The frequency of neurological checks depends on the initial assessment and the setting. In a hospital emergency department, clinical monitoring is frequent, often starting every 15 to 30 minutes for the first few hours, gradually lengthening as the patient’s condition remains stable.
For a person monitored at home after a low-risk fall, the initial monitoring period is concentrated. A common recommendation is to perform a neuro check every one to two hours for the first four to six hours after the injury. This frequent monitoring is designed to catch any rapid deterioration.
Following the initial stabilization, checks can be spaced out to every four hours while the person is awake for the remainder of the first 24 to 48 hours. It is important to wake them every two to three hours during the night to perform a brief check on their responsiveness and orientation.
A decline in any assessment component—such as increased confusion, a change in pupil response, or a new weakness in a limb—is a trigger for immediate action. Any deviation from the established baseline assessment requires an immediate return to the emergency room for re-evaluation. The full monitoring period typically extends for at least 48 hours, as delayed bleeds can occur during this timeframe.
Factors That Increase Monitoring Risk
Certain patient characteristics and circumstances automatically increase the risk profile following a fall, necessitating more cautious and sometimes longer monitoring.
Advanced Age
Advanced age is a significant factor, particularly for adults over 65. Brain tissue shrinkage can create more space for a slow bleed to accumulate before symptoms appear. For this reason, monitoring for older adults may need to be extended past the standard 48 hours.
Medications and Pre-existing Conditions
The use of blood-thinning medications (anticoagulants or antiplatelet drugs) introduces a substantially higher risk of severe bleeding, even from a minor head impact. Patients taking these medications often require immediate medical imaging and a longer period of observation. Pre-existing neurological conditions, like dementia or a history of stroke, can complicate the assessment, as the baseline mental status may already be altered.
Mechanism of Injury
A high-impact mechanism of injury, such as a fall from a significant height or a high-speed strike to the head, also increases the likelihood of severe injury. These compounding factors may lead medical professionals to recommend a more stringent monitoring schedule or observation in a dedicated clinical setting.