Head Injury

This CT scan is an example of Subdural haemorr...Image via Wikipedia

Alternative Names: Brain injury; Head trauma; Contusion

Definition: Head injury is a trauma to the head, that may or may not include injury to the brain (you may click to see also:-> Brain Injury). However, ‘brain injury’ and ‘head injury’ are often used interchangeably in the medical literature.

A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

Head injury is classified as either closed or open (penetrating).

A closed head injury means you received a hard blow to the head from striking an object.
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens 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.
There are several types of brain injuries. Two common types of head injuries are:

Concussion, the most common type of traumatic brain injury
Contusion, which is a bruise on the brain

You may click to see also:->

Subarachnoid hemorrhage
Subdural hematoma

Considerations:Every year, millions of people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection. The symptoms of minor head injuries usually go away on their own. More than half a million head injuries a year, however, are severe enough to require hospitalization.

Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone’s life.

In patients who have suffered a severe head injury, there is often one or more other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury.

Causes: The most Common causes of head injury are traffic accidents, home and occupational accidents, falls, and assaults. Bicycle accidents are also a common cause of head injury-related death and disability, especially among children.

Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. These more serious head injuries may cause:

*Changes in personality, emotions, or mental abilities

*Speech and language problems

*Loss of sensation, hearing, vision, taste, or smell

*Seizures

*Paralysis

*Coma

Types of head injury:
Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull.

Head injuries may be closed or open. A closed (non-missile) head injury is one in which the skull is not broken. 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 a 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 subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy 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).

Specific problems after head injury can include:

*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 temporary 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:
Mild concussions are not associated with any sequelae. However, a slightly greater injury can be 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 some cases the patients may develop postconcussion syndrome, which can include memory problems, dizziness, and depression. Cerebral concussion is the most common head injury seen in children.

Epidural hematoma:
Epidural hematoma (EDH) is a rapidly accumulating hematoma between the dura mater and the cranium. These patients have a history of head trauma with loss of consciousness, then a lucid period, followed by loss of consciousness. Clinical onset occurs over minutes to hours. Many of these injuries are associated with lacerations of the middle meningeal artery. A “lenticular”, or convex, lens-shaped extracerebral hemorrhage will likely be visible on a CT scan of the head. Although death is a potential complication, the prognosis is good when this injury is recognized and treated.

Subdural hematoma:
Subdural hematoma occurs when there is tearing of the bridging vein between the cerebral cortex and a draining venous sinus. At times they may be caused by arterial lacerations on the brain surface. Patients may have a history of loss of consciousness but they recover and do not relapse. Clinical onset occurs over hours. A crescent shaped hemorrhage compressing the brain will be noted on CT of the head. Surgical evacuation is the treatment. Complications include uncal herniation, focal neurologic deficits, and death. The prognosis is guarded.

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.

Symptoms:
The signs of a head injury can occur immediately or develop slowly over several hours. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. (This is called a concussion.) The head may look fine, but complications could result from bleeding inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume the spinal cord is also injured.

The following symptoms suggest a more serious head injury — other than a concussion or contusion — and require emergency medical treatment:

*Loss of consciousness, confusion, or drowsiness

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*Low breathing rate or drop in blood pressure

*Convulsions

*Fracture in the skull or face, facial bruising, swelling at the site of the injury, or scalp wound

*Fluid drainage from nose, mouth, or ears (may be clear or bloody)

*Severe headache

*Initial improvement followed by worsening symptoms

*Irritability (especially in children), personality changes, or unusual behavior

*Restlessness, clumsiness, lack of coordination

*Slurred speech or blurred vision

*Inability to move one or more limbs

*Stiff neck or vomiting

*Pupil changes

*Inability to hear, see, taste, or smell

Diagnosis and prognosis:
Head injury may be associated with a neck injury. Bruises on the back or neck, back pain, pain radiating to the arms is a sign of cervical spine injury meriting spinal immobilization and application of a cervical collar. It is common for head trauma patients to have drowsiness but to be easily aroused, headaches, and vomiting after injury. If exam and consciousness are preserved, this is of no concern. But if these symptoms persist > 1 or 2 days, a CT of the head is needed. In some cases transient neurologic disturbance may occur, lasting minutes to hours and causing occipital blindness and a state of confusion. 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.

Management:
Unfortunately, once the brain has been damaged by trauma, there is no quick fix. However, there are some steps that can be taken to prevent secondary damage. If left untreated many patients with head injury will rapidly develop complications which may lead to death or permanent disability. Prompt medical treatment may prevent the worsening of symptoms and lead to a better outcome. Medical treatment should begin at the scene of the trauma. Paramedics will generally immobilize the patient to ensure no further damage to the spine or nervous system, insert an airway to ensure uninterrupted breathing, and perform endotracheal intubation if indicated. One or more IVs will be inserted to maintain perfusion status. In some cases medications may be administered to sedate or paralyze the patient to prevent additional movement which may worsen the brain injury. The patient should be delivered promptly to a hospital with neurosurgical capabilities. The management of brain injury requires the involvement of subspecialists who are generally available only at larger hospitals. Primary treatment involves 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.

First Aid :

Get medical help immediately if the person:

*Becomes unusually drowsy

*Develops a severe headache or stiff neck

*Vomits more than once

*Loses consciousness (even if brief)

*Behaves abnormally

For a moderate to severe head injury, take the following steps:

1. Call 911.

2.Check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

3.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, keeping the head in line with the spine. and preventing movement. Wait for medical help.

4.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.

5.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.

6.If the person is vomiting, roll the head, neck, and body as one unit to prevent choking. 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.)

7.Apply ice packs to swollen areas.

For a mild head injury, no specific treatment may be needed. However, closely watch the person for any concerning symptoms over the next 24 hours. The symptoms of a serious head injury can be delayed. While the person is sleeping, wake him or her every 2 to 3 hours and ask simple questions to check alertness, such as “What is your name?”

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, as with anyone with a head injury, closely watch the child for 24 hours after the incident.

Over-the-counter pain medicine (like acetaminophen or ibuprofen) may be used for a mild headache. DO NOT take aspirin, because it can increase the risk of bleeding.

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.

Prevention :-

*Always use safety equipment during activities that could result in head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.

*Obey traffic signals when riding a bicycle. Be predictable so that other drivers will be able to determine your course.

*Be visible. DO NOT ride a bicycle at night.

*Use age-appropriate car seats or boosters for babies and young children.

Make sure that children have a safe area in which to play.

*Supervise children of any age.

*DO NOT drink and drive, and DO NOT allow yourself to be driven by someone who you know or suspect has been drinking alcohol.

You may click to See also:->
Extra-axial hemorrhage
Intra-axial hematoma
Intraparenchymal hemorrhage
Brain Trauma Foundation

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm
http://en.wikipedia.org/wiki/Head_injury

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2 thoughts on “Head Injury”

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