Head Injury

Head injuries include: Concussion, in which the brain is shaken, is the most common type of traumatic brain injury. Scalp wounds. Skull fractures.

What Is a Head Injury?

A head injury is any sort of injury to your brain, skull, or scalp. This can range from a mild bump or bruise to a traumatic brain injury. Common head injuries include concussions, skull fractures, and scalp wounds. The consequences and treatments vary greatly, depending on what caused your head injury and how severe it is.

Head injuries may be either closed or open. A closed head injury is any injury that doesn’t break your skull. An open, or penetrating, head injury is one in which something breaks your skull and enters your brain.

It can be hard to assess how serious a head injury is just by looking. Some minor head injuries bleed a lot, while some major injuries don’t bleed at all. It’s important to treat all head injuries seriously and get them assessed by a doctor.

What Causes a Head Injury?In general, head injuries can be divided into two categories based on what causes them. They can either be head injuries due to blows to the head or head injuries due to shaking.

Head injuries caused by shaking are most common in infants and small children, but they can occur any time you experience violent shaking.

Head injuries caused by a blow to the head are usually associated with:

  • motor vehicle accidents
  • falls
  • physical assaults
  • sports-related accidents

In most cases, your skull will protect your brain from serious harm.

Shaken Baby Syndrome

What Are the Major Types of Head Injuries?

Hematoma

A hematoma is a collection, or clotting, of blood outside the blood vessels. It can be very serious if a hematoma occurs in the brain. The clotting can cause pressure to build inside your skull, which can cause you to lose consciousness.

Hemorrhage

A hemorrhage is uncontrolled bleeding. There can be bleeding in the space around your brain, which is a subarachnoid hemorrhage, or bleeding within your brain tissue, which is an intracerebral hemorrhage.

Subarachnoid bleeds often cause headaches and vomiting. The severity of intracerebral hemorrhages depends on how much bleeding there is, but over time any amount of blood can cause pressure to build.

Concussion

A concussion is a brain injury that occurs when your brain bounces against the hard walls of your skull. Generally speaking, the loss of function associated with concussions is temporary. However, repeated concussions can eventually lead to permanent damage.

Edema

Any brain injury can lead to edema, or swelling. Many injuries cause swelling of the surrounding tissues, but it’s more serious when it occurs in your brain. Your skull can’t stretch to accommodate the swelling, which leads to a buildup of pressure in your brain. This can cause your brain to press against your skull.

Skull Fracture

Unlike most bones in your body, your skull doesn’t have bone marrow. This makes the skull very strong and difficult to break. A broken skull is unable to absorb the impact, making it more likely that there will also be damage to your brain.

Diffuse Axonal Injury

A diffuse axonal injury, or sheer injury, is an injury to the brain that doesn’t cause bleeding but does damage your brain cells. Though it isn’t as outwardly visible as other forms of brain injury, diffuse axonal injury is one of the most dangerous types of head injuries and can lead to permanent brain damage and even death.

What Are the Symptoms of a Head Injury?Your head has more blood vessels than any other part of your body, so bleeding on the surface of your brain or within your brain is a serious concern in head injuries. However, not all head injuries cause bleeding. It’s important to be aware of other symptoms to watch out for. Many symptoms of serious brain injury won’t appear right away. You should always continue to monitor your symptoms for several days after you injure your head.

Common symptoms of a minor head injury include:

  • a headache
  • lightheadedness
  • a spinning sensation
  • mild confusion
  • nausea
  • temporary ringing in the ears

The symptoms of a severe head injury include many of the symptoms of minor head injuries. They can also include:

  • a loss of consciousness
  • seizures
  • vomiting
  • balance or coordination problems
  • serious disorientation
  • an inability to focus the eyes
  • abnormal eye movements
  • a loss of muscle control
  • a persistent or worsening headache
  • memory loss
  • changes in mood

When Does a Head Injury Require Medical Attention?

when to see a doctor
 

Head injuries shouldn’t be taken lightly. See your doctor right away if you think you have the symptoms of a serious head injury.

In particular, you should always call 911 or go to an emergency room if you experience loss of consciousness, confusion, or disorientation. Even if you don’t go to the ER immediately after the accident, you should seek help if you still have symptoms after a day or two.

In the case of a potentially serious head injury, you should always call 911. Motion can sometimes make a head injury worse, and emergency medical personnel are trained to move patients carefully without causing more damage.

 

Diagnosing a Head InjuryOne of the first ways your doctor will assess your head injury is with the Glasgow Coma Scale (GCS). The GCS is a 15-point test that assesses your mental status. A high GCS score indicates a less severe injury.

Your doctor will need to know the circumstances of your injury. Often, if you have suffered a head injury, you won’t remember the details of the accident. If it’s possible, you should bring someone with you who witnessed the accident. It will be important for your doctor to determine if you lost consciousness and for how long if you did.

Your doctor will also examine you to look for signs of trauma, including bruising and swelling. You’re also likely to get a neurological examination, in which your doctor will evaluate your nerve function by assessing your muscle control and strength, eye movement, and sensation, among other things.

Imaging tests are commonly used to diagnose head injuries. A CT scan will help your doctor look for fractures, evidence of bleeding and clotting, brain swelling, and any other structural damage. CT scans are fast and accurate, so they’re typically the first type of imaging you will receive. You may also receive an MRI scan, which can offer a more detailed view of the brain. An MRI scan will usually only be ordered once you’re in stable condition.

Head injury – first aidA head injury is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury.

Head injury

Head injury can be either closed or open (penetrating).

  • A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
  • An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This is more likely to happen when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

Head injuries include:

  • Concussion, in which the brain is shaken, is the most common type of traumatic brain injury.
  • Scalp wounds
  • Skull fractures

Head injuries may cause bleeding:

Head injury is a common reason for an emergency room visit. A large number of people who suffer head injuries are children. TBI (traumatic brain injury) accounts for over 1 in 6 injury-related hospital admissions each year.

Causes

Common causes of head injury include:

  • Accidents at home, work, outdoors, or while playing sports
  • Falls
  • Physical assault
  • Traffic accidents

Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

Symptoms

Head injuries may cause bleeding in the brain tissue and the layers that surround the brain (subarachnoid hemorrhage, subdural hematomata extradural hematoma).

Symptoms of a head injury can occur right away. Or symptoms develop slowly over several hours or days. Even if the skull is not fractured, the brain can hit the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull.

The spinal cord is also likely to be injured in any serious trauma.

Some head injuries cause changes in brain function. This is called a traumatic brain injury. Concussion is a mild traumatic brain injury. Symptoms of a concussion can range from mild to severe.

First Aid

Learning to recognize a serious head injury and give basic first aid can save someone’s life. For a moderate to severe head injury, CALL 911 RIGHT AWAY.

Get medical help right away if the person:

  • Becomes very sleepy
  • Behaves abnormally
  • Develops a severe headache or stiff neck
  • Has pupils (the dark central part of the eye) of unequal sizes
  • Is unable to move an arm or leg
  • Loses consciousness, even briefly
  • Vomits more than once
Indications of head injury

Then take the following steps:

  1. Check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing andCPR.
  2. If the person’s breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person’s head. Keep the head in line with the spine and prevent movement. Wait for medical help.
  3. Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person’s head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one.
  4. If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing.
  5. If the person is vomiting, to prevent choking, roll the person’s head, neck, and body as one unit onto his or her side. This still protects the spine, which you must always assume is injured in the case of a head injury. Children often vomit once after a head injury. This may not be a problem, but call a doctor for further guidance.
  6. Apply ice packs to swollen areas.

DO NOT

  • Do NOT wash a head wound that is deep or bleeding a lot.
  • Do NOT remove any object sticking out of a wound.
  • Do NOT move the person unless absolutely necessary.
  • Do NOT shake the person if he or she seems dazed.
  • Do NOT remove a helmet if you suspect a serious head injury.
  • Do NOT pick up a fallen child with any sign of head injury.
  • Do NOT drink alcohol within 48 hours of a serious head injury.

A serious head injury that involves bleeding or brain damage must be treated in a hospital.

For a mild head injury, no treatment may be needed. However, watch for symptoms of a head injury, which can which can show up later.

Your health care provider will explain what to expect, how to manage any headaches, how to treat your other symptoms, when to return to sports, school, work, and other activities, and signs or symptoms to worry about.

Both adults and children must follow the health care provider’s instructions about when it will be possible to return to sports.

When to Contact a Medical Professional

Call 911 right away if:

  • There is severe head or face bleeding.
  • The person is confused, tired, or unconscious.
  • The person stops breathing.
  • You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury.Any injury that results in trauma to the skull or brain can be classified as a head injury. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature.[1] This broad classification includes neuronal injurieshemorrhages, vascular injuries, cranial nerve injuries, andsubdural hygromas, among many others.[2] These classifications can be further categorized as open (penetrating) or closed head injuries. This depends on if the skull was broken or not.[3] Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries. Many of these are minor, but some can be severe enough to require hospitalization.[4]
  • Classification

    Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull.Head injuries can be closed or open. A closed (non-missile) head injury is where the dura mater remains intact. The skull can be fractured, but not necessarily. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area.A head injury may cause skull fracture, which may or may not be associated with injury to the brain. Some patients may have linear or depressed skull fractures.If intracranial hemorrhage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subduralsubarachnoidextradural, andintraparenchymal hematomaCraniotomy surgeries are used in these cases to lessen the pressure by draining off blood.

    Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to a contrecoup effect (the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact).If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull (both are contrecoup injuries).

     
    Private Patrick Hughes, Co. K, 4th New York Volunteers, wounded at the Battle of Antietam on September 17, 1862.

    Specific problems after head injury can include[citation needed]:

    • Skull fracture
    • Lacerations to the scalp and resulting hemorrhage of the skin
    • Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly
    • Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull
    • Traumatic subarachnoid hemorrhage
    • Cerebral contusion, a bruise of the brain
    • Concussion, a loss of function due to trauma
    • Dementia pugilistica, or “punch-drunk syndrome”, caused by repetitive head injuries, for example in boxing or other contact sports
    • A severe injury may lead to a coma or death
    • Shaken baby syndrome — a form of child abuse

    Concussion

    Traumatic brain injury (TBI) is an exchangeable word used for the word concussion. This term refers to a mild brain injury. This injury is a result due to a blow to the head that could make the person’s physical, cognitive, and emotional behaviors irregular.Symptoms may include:Clumsiness, Fatigue, Confusion, Nausea, Blurry Vision, Headaches, and others.Mild concussions are associated withsequelae. Severity is measured using various concussion grading systems.

    A slightly greater injury is associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In all cases the patients develop postconcussion syndrome, which includes memory problems, dizziness, tiredness, sickness and depression.Cerebral concussion is the most common head injury seen in children.

    Intracranial hemorrhage

    Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area.

    Intra-axial hemorrhage

    Intra-axial hemorrhage is bleeding within the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, and intraventricular hemorrhage, bleeding within the brain’s ventricles (particularly of premature infants). Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds.[7]

    Extra-axial hemorrhage

    Hematoma typeEpiduralSubdural       
    LocationBetween the skull and the outer endosteal layer of the dura materBetween the dura and the arachnoid
    Involved vesselTemperoparietal locus (most likely) – Middle meningeal artery
    Frontal locus – anterior ethmoidal artery
    Occipital locus – transverse or sigmoid sinuses
    Vertex locus – superior sagittal sinus
    Bridging veins
    Symptoms(depend on severity)Lucid interval followed by unconsciousnessGradually increasing headache and confusion
    CT appearanceBiconvex lensCrescent-shaped
     

    Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:

    • Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma. It may result from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases in intracranial pressure can result rapidly. However, it is the least common type of meningeal bleeding and is seen in 1% to 3% cases of head injury .
      • Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC)
      • Head CT shows lenticular (convex) deformity.
    • Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater.
      • Head CT shows crescent-shaped deformity
    • Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms orarteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache (a thunderclap headache). This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention.

    Cerebral contusion

    Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. Complications may include cerebral edema and transtentorial herniation. The goal of treatment should be to treat the increased intracranial pressure. The prognosis is guarded.

    Diffuse axonal injury

    Diffuse axonal injury, or DAI, usually occurs as the result of an acceleration or deceleration motion, not necessarily an impact. Axons are stretched and damaged when parts of the brain of differing density slide over one another. Prognoses vary widely depending on the extent of damage.

    Signs and symptoms

    Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurological deficit.Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur.Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizuresnausea and vomitingheadache and a lucid interval, during which a patient appears conscious only to deteriorate later.[8]

    Symptoms of skull fracture can include:

    Because brain injuries can be life-threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation; They have a chance for severe symptoms later on. The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.

    The Glasgow Coma Scale (GCS) is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Glasgow Coma Scale is used in young children. The widely used PECARN Pediatric Head Injury/Trauma Algorithm helps physicians weigh risk-benefit of imaging in a clinical setting given multiple factors about the patient – including mechanism/location of injury, age of patient, and GCS score.[9]

    Causes

    Common causes of head injury are motor vehicle traffic collisions, home and occupational accidents, falls, and assaultsWilson’s disease has also been indicative of head injury.[10]According to the United States CDC, 32% of traumatic brain injuries (another, more specific, term for head injuries) are caused by falls, 10% by assaults, 16.5% by being struck or against something, 17% by motor vehicle accidents, 21% by other/unknown ways. In addition, the highest rate of injury is among children ages 0–14 and adults age 65 and older.[11]

    Diagnosis

    The need for imaging in patients who have suffered a minor head injury is debated. A non-contrast CT of the head should be performed immediately in all those who have suffered a moderate or severe head injury,an MRI is also an option.[12]Computed tomography (CT) has become the diagnostic modality of choice for head trauma due to its accuracy, reliability, safety, and wide availability. The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes.[13]

    Management

    Most head injuries are of a benign nature and require no treatment beyond analgesics and close monitoring for potential complications such as intracranial bleeding. If the brain has been severely damaged by trauma, neurosurgical evaluation may be useful. Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit.

    Clinicians will often consult clinical decision support rules such as the Canadian CT Head Rule or the New Orleans/Charity Head injury/Trauma Rule to decide if the patient needs further imaging studies or observation only. Rules like these are usually studied in depth by multiple research groups with large patient cohorts to ensure accuracy given the risk of adverse events in this area.[14]

    Prognosis

    In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million.[15]In some cases transient neurological disturbances may occur, lasting minutes to hours. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer’s disease later in life.[16]

    Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit spinal immobilization via application of acervical collar and possibly a long board.If the neurological exam is normal this is reassuring. Reassessment is needed if there is a worsening headacheseizure, one sided weakness, or has persistent vomiting.

    To combat overuse of Head CT Scans yielding negative intracranial hemorrhage, which unnecessarily expose patients to radiation and increase time in the hospital and cost of the visit, multiple clinical decision support rules have been developed to help clinicians weigh the option to scan a patient with a head injury. Among these are the Canadian Head CT rule, the PECARN Head Injury/Trauma Algorithm, and the New Orleans/Charity Head Injury/Trauma Rule all help clinicians make these decisions using easily obtained information and noninvasive practices.

    Image result for injury headImage result for injury headImage result for injury headImage result for injury head

Treating a Head InjuryThe treatment for head injuries depends on both the type and the severity of the injury.

With minor head injuries, there are often no symptoms other than pain at the site of the injury. In these cases, you may be told to take acetaminophen (Tylenol) for the pain. You shouldn’t take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, because they can make any bleeding worse. If you have an open cut, your doctor may use sutures or staples to close it. They’ll then cover it with a bandage.

Even if your injury seems minor, you should still watch your condition to make sure it doesn’t get worse. It isn’t true that you shouldn’t go to sleep after you have injured your head, but you should be woken up every two hours or so to check for any new symptoms. You should go back to the doctor if you develop any new or worsening symptoms.

You may need to be hospitalized if you have a serious head injury. The treatment you receive at the hospital will depend on your diagnosis.

The treatment for severe head injuries can include:

Medication

If you have suffered a severe brain injury, you may be given anti-seizure medication. You’re at risk for seizures in the week following your accident.

You may be given diuretics if your injury has caused a buildup of pressure in your brain. Diuretics cause you to excrete more fluids. This can help to relieve some of the pressure.

If your injury is very serious, you may be given medication to put you in an induced coma. This may be an appropriate treatment if your blood vessels are damaged. When you’re in a coma, your brain doesn’t need as much oxygen and nutrients as it normally does.

Surgery

It may be necessary to do emergency surgery to prevent further damage to your brain. For example, your doctors may need to operate to remove a hematoma, repair your skull, or release some of the pressure in your skull.

Rehabilitation

If you’ve suffered a serious brain injury, you’ll most likely need rehabilitation to regain full brain function. The type of rehabilitation you get will depend on what functionality you have lost as a result of your injury. People who have suffered a brain injury will often need help regaining mobility and speech.

Prevention

Although no child is injury-proof, parents can take some simple steps to keep their children from getting head injuries.

Not all head injuries can be prevented. But the following simple steps can help keep you and your child safe:

  • Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
  • Learn and follow bicycle safety recommendations.
  • Do not drink and drive, and do not allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is impaired in another way.
Bicycle helmet - proper usage

Alternative Names

Brain injury; Head trauma

Preventing gastroenteritis

It’s not always possible to avoid getting gastroenteritis, but following the advice below can help stop it spreading:

  • Stay off work, school or nursery until at least 48 hours after the symptoms have passed. You or your child should also avoid visiting anyone in hospital during this time.
  • Ensure you and your child wash your hands frequently and thoroughly with soap and water, particularly after using the toilet and before preparing food. Don’t rely on alcohol hand gels, as they’re not always effective.
  • Disinfect any surfaces or objects that could be contaminated. It’s best to use a bleach-based household cleaner.
  • Wash contaminated items of clothing or bedding separately on a hot wash.
  • Don’t share towels, flannels, cutlery or utensils while you or your child is ill.
  • Flush away any poo or vomit in the toilet or potty and clean the surrounding area.
  • Practice good food hygiene. Make sure food is properly refrigerated, always cook your food thoroughly, and never eat food that is past its use-by date – read more about preventing food poisoning

Take extra care when travelling to parts of the world with poor sanitation, as you could pick up a stomach bug. For example, you may need to boil tap water before drinking it.

Young children can have the rotavirus vaccination when they’re two to three months old, which can reduce their risk of developing gastroenteritis.Image result for gastroenteritis

Image result for gastroenteritis

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