An indicator of expanding intracranial hematoma or rapidly progressing brain swelling is which of the following?

• A. Seizure
• B. Rapid deterioration of neurologic signs
• C. Stable vital signs
• D. Normal pupil reflex

Answer: (B)

Rapid deterioration of neurological signs is the clearest signal that an intracranial hematoma is expanding or brain swelling is rapidly progressing. When a bleed grows or edema increases inside the skull, intracranial pressure rises and can quickly compromise brain function. This often shows up as a sudden drop in level of consciousness, new weakness or speech difficulties, or other abrupt changes in neurological status. It’s a warning that needs immediate attention and rapid transport for definitive care.

Seizures can occur after head injury but don’t consistently indicate that a hematoma is expanding. Stable vital signs don’t rule out rising intracranial pressure, and a normal pupil reflex can be misleading, since ICP can worsen even if pupils are initially reactive.