What is a Head Injury Emergency?

A head injury can be mild to severe, ranging from a mild bump, bruise, or scratch on the head to more severe injuries such as concussion, skull fracture, deep cut or wound on the head, or bleeding on the brain. Head injuries are one of the most common causes of disability and death in adults.

Head injuries cover a wide range of injuries that effect the scalp, skull, brain, and underlying brain tissue and blood vessels in the brain. Head injuries are commonly referred to as brain injuries or traumatic brain injuries (TBI’s), depending on the severity of the brain injury.

Signs and Symptoms

Brain injuries have a wide range of symptoms. A person can experience both physical and psychological symptoms. Sometimes symptoms show up immediately, and sometimes it can take days or weeks for symptoms to appear. It is important to seek immediate medical attention when you’ve had an emergency brain injury.

Mild traumatic brain injury

Symptoms of mild traumatic brain injury include:

Physical symptoms

• Headache
• Dizziness or loss of balance
• Nausea or vomiting
• Trouble with speech
• Fatigue or drowsiness

Sensory symptoms

• Blurred vision
• Ringing in ears
• Bad taste in mouth
• Changes in the ability to smell
• Sensitivity to light or sound

Cognitive, behavioral, or mental symptoms

• Loss of consciousness for seconds or minutes
• State of being dazed and confused or disoriented without loss of consciousness
• Mood swings or mood changes
• Memory problems or concentration issues
• Feeling depressed or anxious, especially if this is atypical
• Sleep disturbances (sleeping too little or too much)

Moderate to severe traumatic brain injury

Symptoms of moderate to severe traumatic brain injuries include:

Physical symptoms

• Loss of consciousness for several minutes to hours
• Persistent headache or headache that gets worse
• Convulsions or seizures
• Recurring nausea or vomiting
• Dilation of one or both pupils
• Clear fluids draining from the ear
• Unable to awaken from sleep
• Loss of coordination
• Weakness or numbness in fingers or toes

Cognitive or mental symptoms

• Profound confusion
• Aggressive behavior, combativeness, agitation, or any other unusual behavior
• Slurred speech
• Coma or other issues or disorders with unconsciousness

Children’s Symptoms

Infants and young children may have an inability or difficulty in communicating symptoms of a traumatic brain injury. Observable symptoms may include:

• Changes in eating or nursing habits
• Abnormal or easy irritability or fussiness
• Persistent crying without an ability to be soothed
• Attention and focus issues
• Sleep disturbances
• Seizures
• Drowsiness
• Sad or depressed mood
• Loss of interest in toys or play

When to See a Doctor

It is critical to seek medical attention if you or your child has experienced a blow to the head or body that has resulted in behavioral changes or any symptoms of traumatic brain injury. Traumatic brain injuries are categorized in severity of mild, moderate, or severe, but even mild traumatic brain injuries need immediate medical attention.

Causes

There are several different causes for traumatic brain injuries. TBI’s are usually caused by a blow or blunt force trauma, and the severity usually depends on the nature of the impact and the force behind it. Common causes for traumatic brain injuries include:

• Falls. Falls that lead to TBI’s are more common in older adults and children. Falls down the stairs, in the shower or bath, out of the bed, or from a ladder are common ways TBI’s occur.
• Vehicle-related collisions. Collisions that involve cars, trucks, or motorcycles hitting each other or colliding into pedestrians are a common cause of TBI’s.
• Sports injuries. TBI’s are common in high-contact sports such as football, lacrosse, soccer, rugby, and basketball. It is most common in high-contact youth sports.
• Violence. Domestic violence, child abuse, and gun violence are common causes for TBI’s. Shaken baby syndrome is a TBI in infants caused by violent shaking.
• Explosions or blasts in combat. TBI’s can happen from blunt force trauma in an explosion or blast and being hit by debris and shrapnel, or from falling. Although research is ongoing, TBI’s can also occur from the pressure wave or intense vibrations from the blast or explosion.

Risk Factors

The people most at risk for traumatic brain injuries include:

• Children, specifically newborns to 4-years-olds
• Teens and young adults ages 15-24
• Adults 65 and older
• Males of any age

Diagnosis

Diagnosis of a traumatic brain injury happens after a physical examination and diagnostic testing. The full picture of the injury may not be understood until well after the initial injury, and after a patient has been taken through a comprehensive medical evaluation, including a physical examination and diagnostic testing. A doctor will also gather a full medical history of the patient and will ask questions about how the injury occurred. Follow-up testing and appointments may be required. Some of the diagnostic tests include:

• Blood tests
• X-rays. A test that uses invisible electromagnetic energy to create images of internal tissue, bones, and organs.
• Computed tomography scan (CT’s or CAT scans). Diagnostic imaging that uses computer and x-ray technology to produce images of bones, muscle, fat, tissue, tendons in any part of the body. This type of imaging test is more detailed than an x-ray.
• Electroencephalogram (EEG). A procedure that records the brain’s electrical activity by hooking electrodes up to the patient’s scalp.
• MRI. Imaging test that uses magnets and radiofrequency to look at the body’s organs, muscles, bones, fat, tissues, or tendons.

Treatment and Recovery

Treatment for a traumatic brain injury is dependent on the severity of the injury. It is important to seek immediate medical care for any traumatic brain injury. Treatment for TBI’s may require immediate emergency care and medications.

Immediate emergency care

Emergency medical care for TBI’s focuses on a person’s oxygen levels, maintaining an adequate blood supply, maintaining appropriate blood pressure, and stabilizing the neck and head to prevent any more damage. Treatment in the emergency or intensive care unit will also try to minimize secondary damage caused by inflammation, blood loss, or drops in oxygen to the brain.

Medications

Medications are often given to help minimize secondary damage immediately after the injury. Medications may include:

• Anti-seizures drugs. There is an increased risk for seizures within the first week after a moderate or severe traumatic brain injury. The anti-seizure drug would be given the first week after the injury to prevent any additional brain damage. The medication is only continued after the first week if there have been recurring seizures.
• Coma-inducing drugs. A patient may be put temporarily into a coma because a comatose brain requires less oxygen to function. This especially helps if blood vessels are compressed and cannot supply normal amounts of oxygen and nutrients to the brain.
• Diuretics. These are given to patients in order to decrease fluid and pressure in the brain.

Surgery

Surgery may be required to minimize additional damage to the brain tissue. Issues that would require surgery on the brain include:

• Removing blood clots on the brain
• Repairing skull fractures
• Bleeding in the brain
• Opening a window in the skull to relieve pressure by draining cerebrospinal fluid or allowing more space for swollen brain tissue

Rehabilitation

Most patients who have suffered a traumatic injury will require some form of rehabilitation. A person may need to relearn basic life skills such as walking, talking, and performing daily life tasks. Rehabilitation usually starts at the hospital and may then move to an inpatient, residential, or outpatient care facility. The type and duration of rehab depends on the severity of the traumatic brain injury and what part of the brain has been affected.

Rehabilitation specialists include:

• Physiatrist
• Occupational therapist
• Physical therapist
• Speech and language therapist
• Neuropsychologist
• Social worker or case manager
• Rehabilitation nurse
• Traumatic brain injury nurse specialist
• Recreational therapist
• Vocational counselor

Complications

The risk of complications after a severe traumatic brain injury is high. Multiple complications can occur immediately following or soon after the injury. The more severe the brain injury is, the greater likelihood for multiple complications that can be severe.

Altered Consciousness

Severe traumatic brain injuries can cause temporary or permanent altered states of consciousness, awareness, and responsiveness. Different states of consciousness include:

• Coma. This results from widespread brain damage. In a coma, a patient is unconscious and unaware of anything and unresponsive to any stimulus. A coma can last days or weeks before a person emerges or enters a vegetative state.
• Vegetative state. Widespread brain damage can lead to a vegetative state, where a person is unaware of their surroundings, but they may open their eyes, make sounds, move, or respond to reflexes.
• Minimally conscious state. A severely altered state of consciousness with some signs of self-awareness or being aware of their environment. This may be a transitional state from a coma or vegetative and indicative of more recovery.
• Brain death. This is an irreversible state when there is no measurable activity in the brain or brain stem. When life supporting devices are turned off, the breathing will stop and lead to eventual heart failure.

Physical complications

• Seizures. Some traumatic brain injuries can lead to seizures early on after the injury, and sometimes the seizures can be recurrent over time. Recurrent seizures over a long period of time after a TBI are called post-traumatic epilepsy.
• Fluid buildup in the brain (hydrocephalus). Sometimes after TBI’s, increased pressure and swelling can happen in the brain due to cerebrospinal fluid building up in the cerebral ventricles.
• Infections. With a skull fracture or penetrating wound, there can be tearing of the protective tissue surrounding the brain, which can allow bacteria to grow and infection to set in.
• Blood vessel damage. Large or small blood vessels can be damaged with a TBI, which can lead to blood clots, stroke, or other issues.
• Headaches. Frequent and persistent headaches are common after TBI’s. They can last up to several months.
• Vertigo. Some people experience this condition of extreme dizziness after suffering a TBI.

If any or several of these symptoms persist well after a few weeks to months from the traumatic brain injury, it is generally referred to as post-concussive symptoms.

Traumatic brain injuries can also cause cranial nerve damage, which is at the base of the skull. An injury to the base of the skull can lead to the following issues:

• Paralysis of facial muscles or loss of sensations in the face
• Loss of or altered state of taste and smell
• Swallowing problems
• Blurred or double vision
• Dizziness
• Ringing in the ear
• Hearing loss

Intellectual problems

Traumatic brain injuries can result in a loss of cognitive abilities such as memory, focus, and attention. It may feel more difficult to think and process your thoughts.

• Cognitive problems. Memory, learning, reasoning, judgment, concentration and attention
• Executive functioning problems. Problem-solving, multi-tasking, planning, organizing, decision-making, beginning and completing tasks

Communication problems

• Difficulty comprehending speech and writing
• Difficulty speaking and writing
• Difficulty in organizing thoughts and ideas
• Difficulty in following along and participating in conversations

Behavioral problems

• Difficulty with self-control or impulsivity
• Unaware of abilities
• Aggression or physical outbursts
• Reckless behavior
• Difficulty in social settings and situations

Emotional changes

• Depression or anxiety
• Noticeable mood swings
• Irritability and anger
• Lack of empathy
• Sleep disturbances

Sensory problems

• Persistent ringing in the ears
• Alterations to taste and smell
• Impaired hand-eye coordination
• Difficulty recognizing objects
• Double vision or blind spots
• Trouble with balance and dizziness
• Skin tingling, pain, or itching

Degenerative brain diseases

Current research is making strides in understanding the impact of traumatic brain injuries on degenerative brain diseases. Some of the research suggests that repeated or severe traumatic brain injuries may increase the risk of developing a degenerative brain disease. However, this risk cannot be predicted for any individual and the research continues to investigate correlations between TBI’s and degenerative brain diseases. Degenerative brain diseases include:

• Alzheimer’s disease
• Parkinson’s disease
• Dementia pugilistica