I'm a little confused about head injuries and head surgeries. I remember learning that for something you are supposed to keep the HOB flat and not to elevate because something (i'm assuming CSF) could leak out. Does this make sense to anyone? I always pick the answer, keep the HOB flat for anything head related and its always wrong. But I know there is at least ONE time where you have to keep the HOB flat. Can someone help me figure out what it is? Its driving me crazy! I'm going to keep getting these questions wrong until I figure out what it is. I read all through my notes and I can't find it.

Is it after a transphenoidal hypothesectomy that you don't want the HOB elevated?

I know from reading my neuro, that you keep the pt lying flat for several hours after a lumbar puncture to keep CSF from leaking... this is done for some head injuries.

As I recall the HOB should be raised (semi or Fowler's position) with the head midline (straight facing) unless there is risk or evidence of CSF leakage which would lower the Inter Cranial Pressure.

The raised HOB helps to avoid increased ICP, so think of it ... if ICP is up so is the HOB, if ICP is down the HOB is down.