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 (penetrating) head injury is one in which something breaks your scalp and 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. However, injuries severe enough to cause head injury can also be associated with injuries to the spine.

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 lead to pressure building up inside your skull. This can cause you to lose consciousness or result in permanent brain damage.

• Hemorrhage

A hemorrhage is uncontrolled bleeding. There can be bleeding in the space around your brain, called subarachnoid hemorrhage, or bleeding within your brain tissue, called intracerebral hemorrhage.
Subarachnoid hemorrhages 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 buildup.

• Concussion

A concussion occurs when the impact on the head is severe enough to cause brain injury. It’s thought to be the result of the brain hitting against the hard walls of your skull or the forces of sudden acceleration and deceleration. Generally speaking, the loss of function associated with a concussion 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. This leads to pressure buildup in your brain, causing 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 of a blow, making it more likely that there’ll also be damage to your brain. Learn more about skull fractures.

• Diffuse axonal injury

A diffuse axonal injury (sheer injury) is an injury to the brain that doesn’t cause bleeding but does damage the brain cells. The damage to the brain cells results in them not being able to function. It can also result in swelling, causing more damage. Though it isn’t as outwardly visible as other forms of brain injury, a diffuse axonal injury is one of the most dangerous types of head injuries. It can lead to permanent brain damage and even death.

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
• leaking of clear fluid from the ear or the nose

How is a head injury diagnosed?

One 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’ve had 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. During this exam, 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’ll receive. You may also receive an MRI scan. This can offer a more detailed view of the brain. An MRI scan will usually only be ordered once you’re in stable condition.

How is a head injury treated?

The 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 (Advil) or aspirin (Bayer). These 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’ve had a severe brain injury, you may be given anti-seizure medication. You’re at risk for seizures in the week following your injury.
You may be given diuretics if your injury has caused pressure buildup in your brain. Diuretics cause you to excrete more fluids. This can help 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 doctor may need to operate to:
• remove a hematoma
• repair your skull
• release some of the pressure in your skull

• Rehabilitation

If you’ve had 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’ve lost as a result of your injury. People who’ve had a brain injury will often need help regaining mobility and speech.