Management of Non-Traumatic Head Lesions
The evidence provided exclusively addresses traumatic head injuries, not non-traumatic lesions, making these guidelines inapplicable to your clinical scenario.
Critical Distinction
All available evidence focuses on blunt or penetrating trauma with specific inclusion criteria requiring documented traumatic mechanisms of injury 1. Non-traumatic head lesions represent an entirely different clinical entity requiring a fundamentally different diagnostic approach.
Appropriate Evaluation for Non-Traumatic Head Lesions
Since the provided trauma guidelines explicitly exclude non-traumatic presentations 1, the evaluation should proceed as follows:
Initial Assessment
- Determine the nature of the lesion: scalp mass, skull abnormality, or concern for intracranial pathology
- Key historical features: timeline of development (acute vs. chronic), associated symptoms (headache, neurologic deficits, seizures), systemic symptoms (fever, weight loss), prior malignancy history
- Physical examination findings: size, consistency, mobility, tenderness, overlying skin changes, presence of neurologic deficits
Imaging Strategy
For suspected intracranial pathology with neurologic symptoms:
- MRI with and without contrast is the preferred initial imaging modality for non-traumatic intracranial lesions, as it provides superior soft tissue characterization compared to CT 1
- MRI better identifies tumors, vascular malformations, infections, and inflammatory processes
For scalp or skull lesions:
- Clinical examination may suffice for obvious benign lesions (lipomas, sebaceous cysts)
- CT head without contrast can evaluate bony involvement if skull pathology is suspected
- MRI with contrast if soft tissue characterization or intracranial extension needs assessment
Common Pitfalls
The trauma decision rules (Canadian CT Head Rule, New Orleans Criteria, NEXUS) do not apply to non-traumatic presentations 1. These tools specifically require documented trauma with loss of consciousness or amnesia as entry criteria 1.
Differential Considerations for Non-Traumatic Head Lesions
Without trauma history, consider:
- Neoplastic: primary brain tumors, metastases, skull lesions
- Vascular: cavernomas (which can present without trauma despite the case report) 2, arteriovenous malformations, aneurysms
- Infectious: abscess, osteomyelitis
- Inflammatory: sarcoidosis, vasculitis
- Dermatologic: scalp masses (cysts, lipomas, malignancies)
Urgent neurosurgical or oncologic consultation is warranted for any concerning intracranial mass lesion or rapidly progressive symptoms, regardless of imaging findings.