This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

HEAD INJURY

A head injury is a physical wound to the head caused by external force or violence. Most head injuries are minor, causing only simple cuts and bruises. Still, it is wise to seek medical attention whenever the head has been hurt. Serious wounds are not always obvious.

Concussion is a common form of head injury. A hard blow to the head or a fall on the end of the spine can cause the brain to shift suddenly within the fluid in the skull. This usually causes a brief loss of consciousness but causes no permanent damage to the brain.

The most common serious head injury is a fracture of the skull. The bone of the skull is either broken or dented, and there is a possibility that bone will push into brain tissue and cause bleeding in the brain. A skull fracture can also cause the brain to swell due to blood or fluid buildup.

WHAT CAUSES HEAD INJURY?

The majority of head injuries result from motor vehicle accidents. Other causes include falls, assaults, sports and recreational injuries, and injuries from blunt machinery. People with seizure disorders such as epilepsy are at risk of hurting their heads during a seizure. Approximately 20% of moderate to severe head injuries cause permanent damage to the structure of the brain. Permanent brain damage can result from skull fractures, bruises or bleeding in the brain, swelling, or tearing of nerve tissue.

WHO GETS IT?

Head injuries are common to all ages and both sexes. One child in ten has a significant head injury during school-age years; one-third of those are hospitalized. Annually in the United States, 50,000 to 70,000 people survive head injuries that are serious enough to harm their physical, psychological or intellectual functioning. Most of these people are between the ages of 15 and 24, and two-thirds are men.

The risk of head injuries goes up with the use of alcohol and drugs. People who engage in contact sports such as boxing, football and hockey are also more likely to injure their heads. But the increased use of children's car seats, seat belts, motorcycle and sports helmets have reduced the overall risk of injury to the head.

WHAT ARE THE SYMPTOMS?

A person should seek medical help after a head injury if there is serious bleeding from the face or head, temporary loss of consciousness, confusion or unusual tiredness. The less alert the person is, the more likely there may be brain damage.

A concussion usually causes a brief period of unconsciousness, a short lapse of memory, lack of energy, dizziness and nausea. If you think you might have had a concussion, you should be watched closely either at home or in a hospital for 24 hours. You should be awakened frequently to make sure you are not becoming unconscious. If loss of memory occurs following a concussion, memory of the distant past probably will return first, followed by more recent memories.

After a concussion, some people experience post-traumatic syndrome. They feel nervous and dizzy, have headaches, and find it difficult to concentrate and sleep.

Other kinds of brain injury can also cause headaches. Seek medical care if you have trouble breathing, persistent confusion and sleepiness, if the pupils of your eyes are of different sizes, or if you experience any paralysis or seizures.

A mild to severe injury that damages the brain can cause ongoing problems. You may experience lack of balance or coordination or you may tire easily. You may lose sensation in parts of the body or have difficulty expressing yourself due to loss of control of the muscles used in speech. As a result of these changes, you may experience changes in the way you feel and behave, as well.

DIAGNOSING HEAD INJURY

Your doctor will start by doing a physical examination and asking about your medical history. In the emergency room, you will be observed to see if you can open your eyes, whether you speak understandable words and can follow instructions, and whether you can move your arms and legs. The doctor will check your pupil size and sensitivity. If you are not able to follow instructions or are drowsy and seem out of touch with reality, the doctor will check for damage inside the brain.

Bleeding may occur between the skull and the brain covering (epidural hematoma) or between the brain covering and the brain itself (subdural hematoma). If excessive amounts of blood collect in the brain, pressure can develop and push the brain into another part of the skull.

A lumbar puncture (spinal tap) may be done to obtain a sample of the fluid (cerebrospinal fluid) that cushions your spinal cord and brain. The doctor may take x-rays of your skull and neck and you may be checked for spinal injury. You may be given a test called a computed tomography (CT). A CT scan is an x-ray technique that is used to assess damage to the brain. It shows more detailed pictures of the brain than a standard x-ray.

TREATMENT

If you are having trouble breathing, a tube may be placed into your windpipe to help circulate oxygen through the blood. Your lung function will be carefully watched to insure proper oxygenation of blood flowing to the brain.

An operation may be performed to reduce pressure on the brain and to clean the wound and prevent infection.

Doctors and nurses will work to keep the pressure inside your brain within the normal range. You will be monitored closely. You may have to keep your head elevated and your neck and head held in a still position to help with drainage.

Your blood pressure must also be watched since pressure in the brain can cause high blood pressure. Medications may be given to lower your blood pressure, and you may be given diuretics to reduce the water content in your body.

WHAT YOU CAN DO

A moderate to severe head injury that damages your brain can also change your thinking and behavior. If your injury is mild, you will recover more quickly if you get plenty of rest and discontinue drug and alcohol use. Try to do as much for yourself as you are able. Programs are available to help you recover, and you can continue to improve for many years after suffering a brain injury.

COPING

Recovery from head injury can be a long process that is shared by your family and friends. It is important for the patient and the family as a whole to grieve for the loss of the way things were before the injury and to realize there is a possibility of long-term or permanent disability. Trying to deny this possibility can slow the recovery process. Even after physical recovery is reached, the injury can cause behavior changes that can take time for both the patient and the family to accept.

Support groups and counseling are available to assist people recovering from brain injuries to accept their limitations and recognize their abilities. These groups also can help to give the family or friends realistic expectations. The injured person must make an emotional adjustment to his or her disability in order to get the most out of rehabilitation. The family's support and acceptance help the patient to achieve the greatest level of independence possible.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

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