DEFINITION
Head injury refers to any damage to the scalp, skull, or brain. There are two general categories of head injuries:

  1. Closed Head injury
    A closed head injury is one in which the skull is not broken open. A common cause of closed head injury is a direct blow to the head. Sudden starts and stops in a motor vehicle may also cause a closed head injury. In such cases, the brain is suddenly thrown with great force against the skull, causing damage to the brain. For example, a boxer who receives a blow to the head may experience brain damage even though the skull is not damaged.



  2. Penetrating Head Injury
    In a penetrating injury, the skull is broken open. Penetrating head injuries occur when some object passes through the skull into the brain. The object itself may cause damage to the brain. For example, a bullet wound to the brain causes damage to the skull as well as to the brain. Pieces of the skull can also be pushed into the brain by the object. These pieces can damage the brain. An open wound to the brain may also lead to an infection that can cause further brain damage.

Both closed and penetrating head injuries can cause damage that ranges from mild to very serious. In the most severe cases, head injury can result in death.



Forms of Head injuries
These include:

  • Skull fractures (broken bones in the skull
    A skull fracture is an event in which one or more of the bones that make up the skull are broken. Skull fractures are serious accidents and require immediate medical attention. Some skull fractures are visible. Blood and bone fragments may be obvious. In some cases, however, there are no visible signs of a skull fracture. In such cases, other symptoms may indicate the possibility of a skull fracture. These include:
  1. Swelling or a dent on any part of the head
  2. Bruises or discoloration around the eyes or behind the ears
  3. Pupils in the eyes having unequal sizes
  4. Blood or clear fluid leaking from the nose or ear



  • Intracranial Hemorrhage
    Bleeding inside the skull may accompany a head injury and may cause additional damage to the brain. A blood clot may also form between the brain and the skull. A blood clot is a mass of partly solidified blood that forms in the body. The clot can press against the brain and interrupt the flow of blood and oxygen through the brain. A reduced flow of oxygen prevents the brain from functioning normally.
  • Brain Damage
    Damage to the brain itself can occur even if the skull itself is undamaged. The brain may move around inside the skull with enough force to cause bruising and bleeding.



Most people have had some type of head injury at least once in their lives, but these events are usually not serious enough to require hospital care. Brain injuries are most likely to occur in males between the ages of fifteen and twenty-four. The most common causes of these injuries are car and motorcycle accidents. About 70 percent of all accidental deaths are due to head injuries, as are most disabilities resulting from accidents.



WHAT ARE THE CAUSES AND SYMPTOMS OF HEAD INJURY AND BRAIN DAMAGE?
The head may be damaged from a direct physical injury to the brain or from some secondary factors. Direct physical head injuries result generally from:

  • Traffic accidents.
  • Sports injuries.
  • Falls.
  • Workplace accidents.
  • Assaults.
  • Bullet wounds.
  • Secondary factors causing damage to the brain may be due to:
  • Lack of oxygen supply.
  • Swelling of the brain.
  • Loss of blood flow to the brain.

Both closed and penetrating head injuries can cause tearing of nerve tissue and widespread bleeding or a blood clot in the brain. Swelling may cause the brain to push against the skull, blocking the flow of blood and oxygen to the brain.



Concussion
Trauma (sudden shock) to the head can cause a concussion. A concussion often causes loss of consciousness without visible damage to the skull. In addition to loss of consciousness, initial symptoms of brain injury include:

  • Memory loss and confusion
  • Vomiting
  • Dizziness
  • Partial paralysis or numbness
  • Shock
  • Anxiety



Post-concussion Syndrome
Mild head injuries usually produce symptoms such as headache, confusion, dizziness, and blurred vision. In some cases, these symptoms may last for a few days or weeks. Up to 60 percent of patients who sustain a head injury experience these symptoms for an even longer period of time. The symptoms can last as long as six months or a year after the injury. This condition is known as post-concussion syndrome.

Post-concussion syndrome is often difficult to diagnose. The symptoms include:

  • Headache
  • Dizziness
  • Mental confusion
  • Behavior changes
  • Memory loss
  • Loss of ability to think clearly
  • Depression
  • Sudden changes in mood



Brain Hemorrhage
Bleeding can also occur deep within the brain. Wherever it occurs, bleeding in the brain is a very serious condition. It can lead to unconsciousness and death. The symptoms of bleeding within the brain include:

  • Nausea and vomiting
  • Headache
  • Loss of consciousness
  • Pupils in the eyes having unequal sizes
  • Listlessness

After a head injury, a person may experience a period when his or her brain does not function normally. The person may become confused, have partial memory loss, and lose the ability to learn normally. Other people experience amnesia (memory loss) that may last for a few weeks, months, or even years. As the patient recovers from the head injury, memory normally returns slowly.

A less common aftereffect of head injury is epilepsy. Epilepsy is a seizure disorder characterized by shaking and loss of control over one’s muscles. Epilepsy occurs as a result of 2 to 5 percent of all head injuries.



SOME TERMS RELATED TO HEAD INJURY

  • Computed tomography (CT) scan:

A diagnostic technique that uses X rays focused on a portion of the body from different directions to obtain a three-dimensional picture of that part of the body.

  • Computerized axial tomography (CAT) scan:

The x ray generated images of the brain are processed with a computer to obtain three dimensional pictures.

  • Electroencephalogram (EEG):

It is a record of the electrical impulses produced by the brain’s activity as a way of measuring how the brain is working.



  • Magnetic resonance imaging (MRI):

It is a diagnostic technique for studying the structure of organs and tissues within the body without using radiation of any kind- instead magnetic field is created to capture three dimensional images of the body part..



  • Positron emission tomography (PET):

This is a diagnostic technique that uses radioactive materials to study the structure and function of organs and tissues within the body.
WHAT TYPE OF TREATMENT CAN BE GIVEN AT HOME FOR HEAD INJURIES?
Minor head injuries may be cared for at home as long as someone is available to watch the injured person. Minor head injuries could result from a fall or a minor accident. These could be:



  • Bruises, goose eggs or minor bleeding
    This type of injury has been suffered by almost everyone during their life time. Children often suffer such injuries during play time. Using an ice pack immediately after the injury will decrease the size of the swelling and the pain goes away in time.
  • Injury from a fall
    When the height of the fall is less than the height of the person and the fall is on to a carpet or another soft surface a visit to a doctor may not be needed.

A head injury is considered minor if:

  • There is no loss of consciousness due to injury.
  • There is no prolonged giddiness, vomiting, numbness or other such symptoms.



An ice pack should be applied at the injured portion of the head. While applying an ice pack care should be taken that:

  • Ice pack is not applied directly to the skin.
  • Ice pack should be applied for 20 to 30 minutes duration at a time.
  • A gap of 2 to 4 hours is essential before repeating the application.
  • Discontinue the application after 24 hours since there is little benefit after that.
  • Use a light towel or cloth to wrap the ice before application.



Medical treatment
Minor head injuries may require some form of medical care.The medical professional will recommend bed rest, application of ice pack and some mild pain reliever. Cuts or such open minor injuries will be:

  • Numbed with an injection.
  • Cleaned with an anti-biotic liquid.
  • Checked for hidden injuries or foreign matter.
  • Closed with stitches (sutures), skin staples or a special type of skin glue.
  • A tetanus shot is given.

The individual is advised to be kept under observation for a period of 24 hours or more to identify any changes in status.

WHAT SHOULD ONE EXPECT AT A HOSPITAL AFTER A SERIOUS HEAD INJURY?
People with serious closed head injuries are almost always admitted to the hospital for observation and repeated studies to assure that the condition does not worsen.



Decompression of the Brain
Occasionally a head injury may cause elevated pressure within the skull. An intracranial pressure (ICP) monitor probe may be surgically inserted into the brain through the skull to measure the pressure. If the pressure rises too high, it may be necessary to do surgery to decompress the brain. Death is possible.

Medication
Some drugs to prevent seizures may be given to prevent or treat seizures that occur from the head injury. Seizures after head injury often do not require treatment because they may not reoccur.

Antibiotics are usually not required in closed head injuries. Some doctors use antibiotics in all cases of the basilar skull fracture. Other doctors do not feel this is useful.



Closed Head Injury Cases
When there is a closed head injury with bleeding inside the skull, the doctor must consider a number of factors to determine the correct treatment. Some of these include the location of the bleeding, severity of the symptoms, any other injuries, and progression of symptoms. Surgery may be needed. Other options include pressure monitors, medication to prevent seizures, and antibiotics to prevent infection. People with this type of injury may need a breathing tube inserted (intubation) to help prevent further brain injury. Angiography may be performed.

Penetrating Head Injury cases
These often require some sort of surgery, usually to remove foreign material or to stop bleeding. Other options include pressure monitors, medication to prevent seizures, and antibiotics to prevent infection. People with this type of injury may need a breathing tube inserted to help prevent further brain injury. Angiography may be performed.



WHAT IS COMPUTERIZED AXIAL TOMOGRAPHY (CAT SCAN)?

The discovery of X-rays in the late 1890s changed the course of medicine. X rays gave doctors a way of seeing into a patient’s body. Hard materials, like bone and teeth, show up clearly in an X-ray photograph.

But X-ray photographs have some serious disadvantages. They provide only a two-dimensional (“flat”) view. They may not show cuts, breaks, lumps, and other disorders behind a bone or some other object. The problem is similar to trying to find out what the back of a person’s head is like by looking at a photograph of his or her face.

In the 1960s, scientists found another way to use X rays that solved this problem. The technique is known as axial tomography. In axial tomography, X-ray photographs are taken of thin slices of an object. The X-ray camera is aimed at one part of the body, and a photograph taken. Then the camera is moved just slightly, and another photograph is taken. This process is repeated over and over again. Eventually, the researchers has a whole set of photographs of a part of the patient’s body.

The X-ray photographs are processed by a computer, which assembles them into a three-dimensional photograph called a computerized axial tomography (CAT) scan or a computed tomography (CT) scan. The final product provides a much more detailed image of the body part being studied.



HOW ARE HEAD INJURIES DIAGNOSED?
Some types of head injuries can be diagnosed based on the symptoms only. It is often difficult to know how serious a head injury is. The fact that a person has a headache following a head injury does not really indicate how serious that injury is.

The extent of a head injury can be determined in a number of ways.

  1. The Glasgow Coma Scale
    It is based on a patient’s ability to open his or her eyes, give answers to questions, and respond to physical stimuli, such as a doctor’s touch. A person can score anywhere from three to fifteen points on this scale. A score of less than eight points on the scale suggests the presence of serious brain damage.



  2. Diagnostic Tests
    Patients who are suspected of having severe brain damage should be referred to a medical specialist. The specialist will usually recommend a series of tests. The most common of these tests are the computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and electroencephalogram (EEG). These tests provide visual images of the brain and of the electrical activity taking place within the brain. They are often helpful in discovering damage to the brain.

Some forms of head injury are still difficult to diagnose, even with the best available tests. In such cases, the advice of experts in head injuries may be necessary for diagnosis and treatment.



WHAT TREATMENT OPTIONS ARE AVAILABLE FOR A HEAD INJURY?
The first step in treating most forms of head injury is to keep the patient quiet in a darkened room. The patient’s head and shoulders should be raised slightly on a pillow or blanket.

The next step in treatment depends on the nature of the injury. In the case of a penetrating wound, for example, surgery may be necessary. In a closed head injury, surgery may also be required to drain blood from the brain or to remove a clot. Surgery may also be needed to repair severe skull fractures.

Hospitalization is often necessary following head injuries. Medical workers will observe a patient to watch for any change in his or her condition. In addition, drugs can be given to prevent seizures. A tube can also be inserted into the brain to drain off excess fluid.

A person with a severe head injury may require long-term treatment. This treatment may be needed to help the person recover mental functions lost as a result of the injury. Long-term treatment can sometimes be conducted in day treatment programs. People with the most severe forms of head injury may need to be cared for in a special institution.



WHAT ARE THE CHANCES OF RECOVERY AFTER A HEAD INJURY?
The best hope for recovery from head injury is prompt diagnosis and treatment. However, the long-term prognosis for head injuries is often difficult to predict in the first few hours or days after an injury. In some cases, the prognosis is not known for months or years.

Individuals who experience mild head injuries often recover completely and fairly quickly. Some symptoms, however, may last for up to a year after the accident. These symptoms include headache, dizziness, and an inability to think clearly. These symptoms can obviously affect a person’s ability to work and to deal normally with other people.

The prognosis for severe head injuries is not as good. Such injuries can often produce permanent physical or mental disabilities. Epileptic seizures are an example. Recovery from a severe head injury may take up to five years or more. The length of recovery often depends on a number of personal factors, such as a person’s age, the length of time the person was unconscious following the injury, the number and location of brain injuries, and the duration of amnesia.



WHAT STEPS CAN BE TAKEN TO PREVENT HEAD INJURIES?
Use of a proper protective head gear is the best way to prevent head injury or to restrict its severity. Severe head injuries can often be prevented by some simple steps. People who take part in contact sports or ride bicycles or motorcycles, for example, should always wear helmets. Seat belts and airbags have prevented many head injuries in car accidents. People who work in dangerous occupations should also wear protective head gear.

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