head injury

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, or 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.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and 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 extent of the head trauma.

What are the different types of head injury?

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
    This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move 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
    This type of fracture 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
    These are fractures that 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 fracture
    This is 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 hematoma
    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 hematoma
    Subdural hematomas occur when a blood clot forms underneath the skull and underneath the 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.
  • Contusion or intracerebral hematoma
    A contusion is a bruise to the brain itself. A contusion causes bleeding and swelling inside of the brain 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.
  • Diffuse axonal injury (DAI)
    These injuries are fairly common and are usually caused by shaking of the brain back and forth, which can happen in car accidents or from falls. Diffuse injuries can be mild, such as with a concussion, or may be very severe, as in diffuse axonal injury (DAI). In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain.

Causes

There are many causes of head injury in children and adults. The most common injuries are from motor vehicle accidents (where the person is either riding as a passenger in the car or is struck as a pedestrian), from violence, from falls, or as a result of child abuse.

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a counter coup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

Symptoms

The person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head injury. However, each individual may experience symptoms differently. Symptoms may include:

  • Mild head injury:
  • raised, swollen area from a bump or a bruise
  • small, superficial (shallow) cut in the scalp
  • headache
  • Moderate to severe head injury (requires immediate medical attention):
  • confusion
  • loss of consciousness
  • blurred vision
  • severe headache
  • vomiting
  • loss of short-term memory, such as difficulty remembering the events that lead right up to and through the traumatic event
  • slurred speech
  • difficult walking
  • dizziness
  • weakness in one side or area of the body
  • sweating
  • pale skin color
  • seizures
  • behavior changes including irritability
  • blood or clear fluid draining from the ears or nose
  • one pupil (dark area in the center of the eye) looks larger than the other eye
  • deep cut or laceration in the scalp
  • open wound in the head
  • foreign object penetrating the head

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

Treatment

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

  • Your age, overall health, and medical history
  • Extent of the head injury
  • Type of head injury
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the head injury
  • Your opinion or preference

At Alimran Medical Center, we may recommend any of the following treatments:

Physiotherapy

Chiropractic

Pulsed radiofrequency

Botox® injections

Acupuncture

Prolotherapy

Repetitive transcranial magnatic stimulation (rTMS)