Faq On Head Injury! All You Wanted To Know
Dr. Shailendra Anjankar
MBBS, M.S, DNB ( Neurosurgery)
Head injury can be simple as small swelling on head due to trival fall at home to as serious as large blood clot in head after road accident making person unconscious, having vomiting, and seizures.
There is primary injury to head due to actual trauma, which can be only prevented. Secondary injury to brain occurs after this event and can cause increase in swelling of brain in turn increasing the pressure inside brain resulting in weakness, seizures and breathing difficulty. Neurosurgical management in hospital is directed toward the treatment of this secondary injury to the brain.
Orange City Hospital encourages the public to learn as much as they can about head injuries. To help, we have prepared a list of frequently asked questions and answers that you might have.
Most of the small trauma to head does not require treatment in young and adults. But in the elderly age group, there may be chances of developing chronic slow bleeding after minor trauma to head. So, if there is forgetfulness, increase in headache, vomiting, seizure /fits, bleeding from the nose or ear neurosurgeons consultation is required to rule out serious head injury. Thus, it becomes important to observe the geriatric population after a head injury for a few days following.
Symptoms are due to direct damage to the brain or secondary to raised intracranial pressure
- Headache
- Nausea and vomiting
- Loss of consciousness
- Amnesia (loss of memory)
- Diplopia (double vision)
- Weakness in limbs
- Facial weakness
- Numbness in limbs
- Imbalance in walking
Head injury are graded as mild, moderate and severe depending on GCS – Glassgow Coma scale – a scoring used internationally for grading the head injury by doctors.
- Mild is GCS 14 and 15.
- Moderate is GCS 9 to 13.
- Severe is GCS 3 to 8.
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Initial Glassgow coma score (3- 15)
- Age of the Patient
- Eyes reaction to light and size of the pupils in the eyes
- Hypotension, low Oxygen in blood and Anemia
- Individual CT findings.
- Penetrating injuries or blunt injuries with breach of the skull.
- Presence of expanding intracranial hematoma ( blood collection).
- Epidural Hematoma (EDH)
- Subdural Hematoma (SDH)
- Malignant cerebral edema
- Left side bleed will cause right side weakness usually and he will also have difficulty to talk and same side i.e. left side pupils in the eye will become dilated.
Yes, forgetting how the trauma happened is the confirmatory sign of head injury.
No. All head injury patients usually don’t require brain imaging.
- New Orleans Criteria – CT imaging is required for patients with minor head injury with any one of the following findings. The Criteria ONLY apply to patients who have a GCS of 15.
- Headache
- Vomiting
- Age > 60 years
- Drug or Alcohol Intoxication
- Persistent difficulty in remembering new information
- Visible trauma above the collar bone.
- Seizure
Hospital Admission is required for all patients at higher risk for complications including:
- GCS < 15
- Abnormal CT Scan
- Seizure Activity
- Abnormal Bleeding Parameters
- Unable to be observed at home
A – Alcohol
E – Endocrine/ Electrolyte
I – Insulin
O – Opiate/Oxygen
U – Uremia
T – Toxin/Trauma/Temperature
I – Infections
P – Psychiatric/ porphyria
S – SAH, Stroke, Space Occupying Lesion inside the head, Shock
- GCS <8
- Loss of airway reflexes functioning or presence of signs/ symptoms of an airway injury
- Low Partial pressure of O2 in arterial blood on room air or more Partial pressure of CO2
- Severe facial injuries
- Seizures
- After mild head injury anticonvulsants i.e medications to prevent seizures are given for maximum 7 days. But if there is seizure later or the patients with severe head injury with penetrating brain injury they are given for about 3 years.