After a head injury, which finding would be most urgent to report?

• A. Normal pupil size bilaterally
• B. Slurred speech
• C. Unequal pupils
• D. Tongue numbness

Answer: (C)

After head injury, pupil changes are a key warning sign of brain pressure and possible herniation. When one pupil becomes unequal and particularly if it is dilated and nonreactive to light, this points to compression of the oculomotor nerve from rising intracranial pressure and potential brainstem involvement. That scenario indicates a true emergency requiring immediate reporting and rapid medical intervention.

Normal pupil size on both sides is reassuring and suggests no acute brainstem injury at that moment. Slurred speech can arise from many causes and, while concerning, is less specific for rapid deterioration after head injury. Tongue numbness reflects cranial nerve sensation changes but doesn’t by itself signal imminent brain herniation. The unilateral, nonreactive, dilated pupil is the red-flag finding that most urgently needs attention.