Head trauma

Overview

Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion) or cut on the head. It can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s) or from internal bleeding and damage to the brain. Trauma to the head can cause neurological problems and may require further medical follow up.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the intensity of trauma.

Causes

The most common traumatic injuries are from motor vehicle accidents (automobiles or motorcycles), results of violence, falls and child abuse. Subdural hematomas and brain hemorrhages (called intraparenchymal hemorrhages) can sometimes happen spontaneously.

Symptoms

A person may have varying degrees of symptoms associated with the severity of the head injury. Symptoms may include:

  • Mild head injury:
    • Raised, swollen area from a bump or a bruise
    • Small, superficial (shallow) cut in the scalp
    • Headache
    • Sensitivity to noise and light
    • Irritability
    • Confusion
    • Lightheadedness and/or dizziness
    • Problems with balance
    • Nausea
    • Problems with memory and/or concentration
    • Change in sleep patterns
    • Blurred vision
    • Tired eyes
    • Ringing in the ears (tinnitus)
    • Alteration in taste
    • Fatigue or lethargy
  • Moderate to severe head injury (requires immediate medical attention)--symptoms may include any of the above plus:
    • Loss of consciousness
    • Severe headache that does not go away
    • Repeated nausea and vomiting
    • Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event
    • Slurred speech
    • Difficulty with walking
    • Weakness in one side or area of the body
    • Sweating
    • Pale skin color
    • Seizures or convulsions
    • Behavior changes including irritability
    • Blood or clear fluid draining from the ears or nose
    • Pupil dilation
    • Deep cut or laceration in the scalp
    • Open wound in the head
    • Foreign object penetrating the head
    • Coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
    • Vegetative state (a condition of brain damage in which a person has lost awareness of surroundings)
    • Locked-in syndrome (a neurological condition in which a person is conscious, but cannot speak or move)

The symptoms of a head injury may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.

Types

The following are some of the different types of head injuries:

  • Concussion. A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.
  • Skull fracture. A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:
    • Linear skull fractures, the most common skull fracture, is a break in the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.
    • Depressed skull fractures may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.
    • Diastatic skull fracturesoccur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.
    • Basilar skull fractures are the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
  • Intracranial hematoma (ICH). There are several types of ICH, or blood clots, in or around the brain. The different types are classified by their location in the brain. These can range from mild head injuries to quite serious and potentially life-threatening injuries. The different types of ICH include the following:
    • Epidural hematomas occur when a blood clot forms underneath the skull but on top of the dura, the tough covering that surrounds the brain. They usually come from a tear in an artery that runs just under the skull called the middle meningeal artery. Epidural hematomas are usually associated with a skull fracture.
    • Subdural hematomas occur when a blood clot forms underneath the skull and dura but outside of the brain. These can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. They are sometimes, but not always, associated with a skull fracture.
    • Contusions, or intracerebral hematoma, are bruises on the brain. A contusion causes bleeding and swelling inside of the brain and around the area where the head was struck. Contusions may occur with skull fractures or other blood clots such as a subdural or epidural hematoma. Bleeding that occurs inside the brain (also called intraparenchymal hemorrhage) can sometimes occur spontaneously. When trauma is not the cause, the most common causes are high blood pressure in adults, bleeding disorders, the use of medications that cause blood thinning or illicit drugs.
    • Diffuse axonal injuries (DAI) are fairly common and are usually caused by shaking of the brain. This can happen in car accidents, from falls or shaken baby syndrome. Impact of a diffuse injuries can range from a mild concussion to a severe diffuse axonal injury. In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain.

Diagnosis

The following are some of the different types of head injuries:

  • Concussion. A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.
  • Skull fracture. A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:
    • Linear skull fractures, the most common skull fracture, is a break in the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.
    • Depressed skull fractures may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.
    • Diastatic skull fractures.occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.
    • Basilar skull fractures are the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
  • Intracranial hematoma (ICH). There are several types of ICH, or blood clots, in or around the brain. The different types are classified by their location in the brain. These can range from mild head injuries to quite serious and potentially life-threatening injuries. The different types of ICH include the following:
    • Epidural hematomas occur when a blood clot forms underneath the skull but on top of the dura, the tough covering that surrounds the brain. They usually come from a tear in an artery that runs just under the skull called the middle meningeal artery. Epidural hematomas are usually associated with a skull fracture.
    • Subdural hematomas occur when a blood clot forms underneath the skull and dura but outside of the brain. These can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. They are sometimes, but not always, associated with a skull fracture.
    • Contusions, or intracerebral hematoma, are bruises on the brain. A contusion causes bleeding and swelling inside of the brain and around the area where the head was struck. Contusions may occur with skull fractures or other blood clots such as a subdural or epidural hematoma. Bleeding that occurs inside the brain (also called intraparenchymal hemorrhage) can sometimes occur spontaneously. When trauma is not the cause, the most common causes are high blood pressure in adults, bleeding disorders, the use of medications that cause blood thinning or illicit drugs.
    • Diffuse axonal injuries (DAI) are fairly common and are usually caused by shaking of the brain. This can happen in car accidents, from falls or shaken baby syndrome. Impact of a diffuse injuries can range from a mild concussion to a severe diffuse axonal injury. In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain.

Treatment

Treatment is individualized based on the extent of the condition.. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull).

Specific treatment of a head injury will be determined by your doctor based on:

  • Age, overall health and medical history

  • Type of head injury

  • Extent of the head injury

  • Tolerance for specific medications, procedures or therapies

  • Expectations for the course of the head injury

  • Your opinion or preference

Depending on the severity of the injury, treatment may include:

  • Topical antibiotic ointment and an adhesive bandage
  • Stitches

  • Hospitalization for observation

  • Moderate sedation
  • Mechanical assistance for breathing
  • Surgery

For an ambulance, please call:

Nassau or Suffolk: (516) 719-5000

Manhattan: (212) 434-4911

Queens, Brooklyn or Staten Island: (718) 747-4911

(888) 321-DOCS

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