Acute Head Injury

Acute Head Injury

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Overview

Head injury may occur due to any mild or severe trauma to the skull, brain or scalp that may result in slight swelling, bruise or a traumatic brain injury. Concussions, scalp wounds, and skull fractures are some of the common traumatic brain injuries.

What is an acute head injury?

The effect of the trauma can be assessed after correlation of physical examination, symptoms, signs and investigatory reports.

Head injuries can either be open or closed. A closed injury does not expose the brain, while an open injury penetrates the brain breaking up the skull.

What are the causes of an acute head injury?

The extent of injury may depend on the intensity of trauma and the type of impact. A brain injury may happen due to:

  • Motor Vehicle accidents
  • Falls
  • Sports Injuries
  • Explosive blasts
  • Gunshot or knife wounds
  • Domestic Violence

What are the symptoms of an acute head injury?

The symptoms of a head injury can be numerous depending on the impact on the skull or brain.

Mild Injury

  • Headache
  • Nausea
  • Vomiting
  • Fatigue
  • Dizziness
  • Loss of balance
  • Speech difficulties
  • Blurred vision
  • Ringing or sound in ears
  • Sensitiveness to light & sound
  • Changes in the ability to smell and taste

Mental Symptoms

  • Anxiety
  • Lack of concentration
  • Confusion
  • Disorientation
  • Mood swings
  • Sleepiness
  • Memory loss
  • Temporary loss of consciousness

Moderate to severe head injury

Symptoms might appear within the first hour or even after a few hours.

  • Continuous vomiting and nausea
  • Loss of consciousness for short periods
  • Severe headache
  • Dilated pupils
  • Discharge of clear fluid from nose and ears
  • Seizures
  • Numbness in hands and toes
  • Loss of orientation
  • Agitation
  • Unresponsive to commands.
  • Unaware of surroundings
  • Unclear speech
  • Coma, in extreme cases

What are the types of acute head injuries?

Trauma to the head can result in various types of injuries that may increase pressure within the brain.

  • Hematoma: The formation of a blood clot outside the blood vessels is called a hematoma. Hematomas can be life-threatening if present in the brain, as they can raise the intracranial pressure and lead to symptoms like loss of consciousness & brain damage.
  • Concussion: It happens when there are multiple back and forth collisions between the brain and the hard surface of the skull due to a blow or jolt to the head. It can have a temporary impact on the brain, resulting in headaches, nausea, vomiting, dizziness, and loss of concentration or memory.
  • Haemorrhage: This is the bleeding inside the brain due to the trauma. If the bleeding occurs in the portion between the brain and the skull, then it is called subarachnoid haemorrhage (SAH). It can lead to increased intracranial pressure in the brain. Intracerebral haemorrhage is the one that occurs inside the brain tissue.
  • Contusions: This is the bruising of the brain tissue in which there is swelling or leakage of blood from tiny capillaries due to the trauma on the brain.
  • Oedema: Whenever an injury occurs in any part of the brain, swelling is likely to occur. Likewise, when a brain injury happens, oedema occurs, which can be fatal if there is an increase in the intracranial pressure. Diffuse Axonal Injury: This is a severe form of injury in which the damage may not be visible externally, but functional disturbances are evident due to brain damage. There is impairment of the functioning of the axons affecting the functions of various parts of the brain. Depending on the section of the brain affected, the symptoms appear gradually.
  • Skull Fracture: When the impact on the brain is too intense, it may result in a fracture of the skull that protects the brain. In extreme cases, the damage may be extended to the brain tissue as well. A simple linear fracture can be treated without much medical intervention, whereas complex fractures require surgical intervention.

What are the complications of an acute head injury?

  • Seizures
  • Vertigo
  • Infections
  • Blood vessel Damage
  • Headaches
  • Vision and hearing problems
  • Altered smell or taste
  • Difficulty in speaking and understanding
  • Speech problems

Severe Complications

  • Cognitive disability
  • Altered consciousness
  • Coma
  • Brain Death

How is an acute head injury diagnosed?

In cases of acute head injury, the doctors do not have much time to diagnose the condition. They have to decide the treatment process based on the information extracted from the following procedures:

  • Details of the incident that caused the injury from the patient, if conscious or other people present at the site.
  • Comprehensive physical examination with a particular focus on the neurological examination
  • Glasgow Coma Scale
  • Intracranial Pressure monitoring
  • MRI/CT scan

How is an acute head injury treated?

Irrespective of whether symptoms are present or not, adequate treatment should be started as soon as the injury occurs. The treatment shall vary as per the intensity of the injury:

  • Mild Injury:A mild head injury can be treated with adequate rest and medications to alleviate a headache or any other symptom if present. However, there is a need to monitor the appearance of any new symptoms or signs so that the doctors can be consulted immediately. Regular follow-ups with the doctor is a must.
  • Moderate to Severe Cases:Other than the mild cases, acute head injuries usually require treatment with both medications and surgery.
  • Emergency care:The patient's vitals means the oxygen saturation, blood pressure, heart rate, and breathing are monitored for any abnormalities. Any discomfort or pain in the head or neck is closely checked. The emergency treatment helps in preventing any further complications to the present condition.
  • Medications:The doctors may prescribe the following medications:
    • Diuretics: Due to the accumulation of blood, there is a likelihood of increased intracranial pressure in the brain. Diuretics help release the extra fluid in the tissues, which would help release the extra pressure in the brain tissues.
    • Anti Seizure Drugs: After an acute head injury, epileptic attacks are anticipated as a complication. These medicines help prevent further brain damage, thus preventing seizure attacks, especially in the first week after the injury.
    • Coma - Inducing drugs: These drugs might be prescribed to suppress brain function a little. After a trauma, the blood supply is significantly hampered, and thus, brain cells can remain deprived of the nutrients and oxygen that can augment the brain damage. A comatose brain's requirement for nutrients and oxygen is less; thus, further complications can be prevented.
  • Surgery:Surgical intervention might be required in the following scenarios:
    • Haematomas: There may be blood clots inside the skull or inside the brain tissue, which can cause a rise in the pressure in the brain. These clots have to be removed surgically.
    • Haemorrhage: Bleeding inside the brain tissue or in the portion between the brain and skull has to be rectified surgically.
    • Craniotomy: Rise in intracranial pressure requires opening up the skull and relieving the pressure inside the brain.
    • Skull Fracture: If a compound fracture in the skull that has damaged the brain or bone pieces has penetrated the skull, they have to be removed, and the fracture needs to be repaired.
  • Rehabilitation:The rehabilitation process begins when you are at the hospital itself. The extent of physical and mental therapy depends on the extent of brain damage and the symptoms. If there is an issue in basic activities like walking, eating, drinking, speaking, then staying at the hospital can be prolonged. Further therapy can be done while you are at home and scheduling further visits to the therapy team, consisting of a physical therapist, occupational therapist, neuropsychologist, speech & language therapist, social worker, and rehabilitation nurse.

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