“What is the best way to determine internal head injury?”

Simple, usually. Are there any new symptoms that are referable to the brain? Change in memory, cognition, drive & motivation, emotions? Some malfunction such as a lock of coordination somewhere, weak spots, etc.Usually something is obvious with a traumatic brain injury. If she has deficits, see a neurologist. But random testing is usually negative, and expensive, If you are still concerned, see a neurologist. Best wishes!

It would depend to some degree when her accident occueerd. For days or even weeks, studies such as an MRI may not show any changes. Occasionally edema can be seen at the site of the blow. Generally, if she did not have any loss of consciousness or prolonged disorientation, it would be unlikely that she had any internal injury. If over time you see a change in personality, behavior, or grades, then an MRI might show something but it would most likely require neuropsych testing to reveal any deficits. With even a casual blow to the head, the most likely neurological change would be in attention or concentration. Often with a subtle blow to the head this eventually resolves. I think that it’s most likely that her scalp and skull dissipated any force from such a fall and I think it is unlikely that she sustained any internal injury.

You would really need to go to the local ER for a head CT. There is no other way to tell for sure.

Charles Clarke, M.D.

If her neurological exam is normal, then it's unlikely she's suffered a brain injury.

Get neuroimaging, such as head CT or brain MRI.

Although head CT and possibly a spinal tap could confirm or exclude bleed, yet it does not replace seeing a neurologist.

Nothing is 100%. But one major thing to look for is change in behavior or alertness. A slowly growing collection of blood results in slow decline and worsening sleepiness. But a 24 year old rarely gets this sort of thing - they are more likely to have a faster going bleed. So if there is no rapid change, then she is probably OK.

Getting a CT scan can be done as an outpatient, of course, if you speak to your own doctor. If you start feeling more nervous about it, then it warrants a trip to the emergency department.