Head injuries

Head injuries . They are produced by a strong impact on the head that comes from outside, for example, by a crash, a collision, a traffic accident or playing sports. The consequences of this type of injury can be mild or severe.

Table of Contents

Summary

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1 Head trauma
- 1 Brain trauma
- 2 Incidents
- 3 Causes of injuries
- 4 Symptoms
- 5 Diagnosis
2 Treatment
- 1 First aid
3 Evolution
4 Prevention
5 Source

Trauma to the head

They are the consequence of external impacts due to a fall, collision, shock or blow to the head (for example, during sports practice or in traffic accidents), which result in a skull injury that affects or not the brain . The head injury can be classified into different degrees depending on the severity of the injury:

Cranial contusion
Cranial fracture, which affects various bones of the skull:
The nasal bone (nasal fracture)
Cranial Vault (Cranial Fracture) Head Injury89.jpeg
The base of the skull (fracture of the base of the skull)
The facial skeleton (fracture of the skull face)

Chances are you’ve hit your head once. In general, the injury is minor since the skull is hard and protects your brain. But other head injuries can be more serious, such as a fracture, concussion, or traumatic brain injury . Head injuries can be open or closed. A closed injury does not break the skull. In an open injury, an object penetrates the skull and enters the brain. Closed injuries are not always less serious than open ones.

Brain trauma

A brain-damaged head injury, with damage to brain tissue or its functions, is called craniocerebral trauma. This type of injury is further divided into closed traumatic brain injuries (intact meninges) and open traumatic injuries (damaged meninges). Brain injuries themselves are, by definition, divided as follows:

Contusion (commotio cerebri) without changes or only very small brain tissue
Cerebral contusion (contusio cerebri). Brain tissue abnormalities are highly localized (injury to the cerebral cortex from a contusion)
Brain compression (compressio cerebri) with parts of the brain tissue significantly altered

Head injuries involving an open wound with heavy bleeding may seem much more serious than they really are. Conversely, life-threatening brain damage is often very difficult to diagnose externally. For this reason, a serious head injury can go unnoticed.

Incidents

Injuries to the head caused by traffic accidents, at home or playing sports occur with great frequency. Athletes are at risk of head injury with brain and brain damage in falls, for example when cycling, horseback riding, skiing, skating or gymnastics, or in contact sports such as boxing, soccer, handball, ice hockey.

In school sports, approximately 13% of accidents cause general head injuries. In Spain, each year, approximately 200 out of 100,000 people have a light traumatic brain injury and about 15 to 20 out of 100,000 people suffer a serious injury.

Causes of injuries

The cause of head injuries are usually external impacts caused by accidents such as shocks, bumps or head impacts, which can occur in many situations: in sports, at home, work accidents, traffic and many others. . In sports , the risks are better known, and therefore can be prevented to some extent.

A head injury that involves the brain but that keeps the brain membranes intact (traumatic brain injury closed), can have two causes:

Casual impact occurs while the head is not moving, due, for example, to a concussion, or a forceful impact with the immobile head, such as a blow with a racket. These head injuries often cause local damage to the brain.
Casual impact occurs with the head moving freely: the cause may be a rapid acceleration (for example, by a blow) and a sudden deceleration with rapid movement of the body. The reason is that these events often stop the movement of the head, but not the movement of the brain, so the brain bounces off the skull (jerk). This creates a negative pressure that tears the blood vessels and tissue on the other side. In addition, the brain recoils and the same occurs in the other part in a reduced way (frontal blow). Such injuries are often accompanied by cerebral hemorrhage.

Head injury with damage to the brain membranes (open craniocerebral injury) can arise if in the fracture of the skull bone fragments reach the brain, deposit and tear the external meninges, or even if sharp objects penetrate the skull up to the brain.

Possible causes of this type of injury are, for example, falls when playing sports such as horse riding or cycling (especially if those affected do not wear a helmet), when jumping with a pole or riding a motorcycle, and the blows of professional boxing on the nose and the eyes. Head injuries with a skull fracture are due to strong impacts that exceed the elasticity of the bone.

Symptoms

Symptoms in head injuries depend on the nature and severity of the injury:

Cranial contusion Head injuries may seem more serious than they really are: the scalp is the most irrigated area of skin in the human body. Therefore, minor head injuries, such as a head contusion, cause heavy bleeding. The main symptoms of head contusion are headaches and a local injury. Neurological symptoms (i.e., signs of nerve dysfunction) such as nausea, memory loss, or dizziness are missing in a head contusion.

Brain injury If a head injury affects the brain, so-called neurological symptoms are caused. Brain injury can be in the form of a concussion, or a concussion:

In the cerebral contusion (commotio cerebri) depending on the case, a wound can be seen. If not, this does not exclude a concussion or any other injury to the brain. The following symptoms occur after a concussion head injury: headaches , partly severe, dizziness , sometimes with nausea and vomiting . Memory loss with gaps from the time of the accident is typical. This so-called anterograde amnesia can last for several hours. In severe concussions a loss of consciousness can occur that almost always lasts more than five hours.
Head injuries with cerebral contusion are shown by changes such as: hemorrhages in the superficial cortical layers of the brain (injury to the cerebral cortex due to a contusion). These symptoms appear on the side where the casual impact has occurred (such as accident, shock, blow or impact), or on the opposite side. Loss of consciousness in a brain contusion usually lasts for more than five hours.
Small cerebral hemorrhages (compressio cerebri) can cause minor bleeding due to compression of individual areas in adjacent regions of the brain. It is typical of a brain compression that the brain is damaged not only at the point of impact, but also on the opposite side, by the effect of knock and kickback reaction. The symptoms of these head injuries are more pronounced: loss of consciousness from brain compression lasts much longer than a concussion, even several days. Memory gaps, unlike bruising, are not only from the accident, but can span the period before the accident (retrograde amnesia). Other manifestations of brain compression head injury are hemiplegia (hemiparesis), language dysfunction, or mental changes.

Sequelae and treatment after head injury

Diagnosis

For all head injuries, it is very important to make a good diagnosis and accept the possibility that the brain may be affected. Even if patients do not show disturbances of consciousness or other neurological symptoms (i.e. signs of nerve dysfunction), urgent transfer to a clinic is necessary.

Regarding head injuries, regardless of whether there is external damage to the skull, it is necessary to use imaging techniques in addition to clinical and neurological examinations. To better define the treatment, the doctor must know where the bleeding is and its intensity. Using computed tomography (CT) or magnetic resonance tomography (MRI), bleeding in the brain can be detected safely. In addition, the doctor can determine by this method the existence and location of a cerebral edema.

On the first neurologic examination after head injury, the “Glasgow Coma Scale” may be helpful; It is a standardized scheme in which the doctor can consult the most important neurological parameters, with a point system to evaluate and document. The fewer points the diagnosis indicates, the more serious the neurological disorder is.

Treatment

First aid

In the head injury, medical treatment is first aid, which can be performed instantly with those affected on the spot, for which the following is very important:

If there are bleeding head injuries it is recommended to stop the bleeding with sterile gauze.
If there is loss of consciousness after head injuries, it is necessary to observe the affected person and constantly watch. It is also important, as first aid in case of unconsciousness, that the victims are placed on their side immediately to avoid suffocation due to vomiting, mucus or falling of the tongue backwards.
When breathing is interrupted after a head injury, artificial respiration must be started immediately.

Even if those affected by head injuries do not show signs of clouding of consciousness or other neurological defects (for example, symptoms of brain dysfunction) and first aid does not seem necessary, for their subsequent treatment they should be transferred quickly to a hospital , where the wounds can be sutured or a special bandage applied.

Brain injury

In head injury that affects the brain, treatment depends on the type of brain injury: concussion requires bed rest for several days. It is important that people with a concussion protect themselves from light and noise and stay in a supervised hospital all day. It may be necessary to treat the symptoms of headaches and nausea with medication.

In traumatic brain injury with severe brain injury such as brain contusion or brain compression, close monitoring for a few days in hospital is important. A restriction of consciousness may also require follow-up with intensive care. In the treatment of head injuries, it is also essential to carry out repeated studies with imaging techniques (CT, MRI), to detect bleeding and accumulation of water in the injured areas of the brain (cerebral edema) as soon as possible. In cerebral edema increases the accumulation of water, either in the whole brain or in one part, significantly. Since the skull vault cannot accommodate this increased volume, the pressure inside the skull can increase and be life threatening.

Evolution

Head injuries without signs of brain dysfunction (for example, paralysis or nerve damage) have a very good prognosis. This depends on the duration of recovery (rehabilitation) and the nature and severity of the injury:

Mild head injuries with wounds may seem serious, but they usually have a favorable evolution: head wounds, once sutured, heal after seven to ten days, in most cases without complications. Head injuries with damage to the brain, on the other hand, can take weeks or months until full recovery.

Brain injury

If the head injury affects the brain, the evolution depends to a great extent on the brain injuries. Mild concussion disappears in most cases within 24 hours. If the headaches stop, a seven-day rest is recommended, and then nothing stands in the way of light physical exercise.

Cerebral contusion or brain compression also tend to have a good prospect of rapid and complete recovery. It is a prerequisite of the favorable course, however, that there are no complications, such as cerebral edema or cerebral hemorrhage. If there is a serious evolution, the brain injury usually has lasting effects such as headaches, dizziness, increased sensitivity to light and an overall reduction in performance. The degree of permanent damage cannot be estimated until two to three years after the head injury.

In the case of serious injuries with brain damage and damaged brain tissue or in highly altered functionality, it may take weeks or months before the patient’s degree of healing can be evaluated. It is important that those affected by traumatic brain injury are treated in appropriate facilities. In severe brain injuries, permanent damage such as language disorders, hemiplegia, or epilepsy is not uncommon.

Prevention

Many of the head injuries are easily preventable. The best, easiest and really only option to prevent a head injury is the use of a suitable protective helmet when playing risky sports ( skiing , cycling, skating or climbing, for example).