Head Injury: Types, Symptoms, Complications and Treatment

Overview

Head injury can also be called brain injury or traumatic brain injury. Head injury is one of the most common and serious causes of disability and death in all age groups. A head injury is a broad term that is used to describe an injury to the skull, brain, scalp, and underlying tissues and blood vessels in the head. The severity of the condition depends upon the extent of injury it has caused to the brain.

How common are head injuries seen?

The incidence of head injury is increasing dramatically over a period. According to the studies, every year approximately about 1.7 million traumatic brain injuries occur.

Types of head injuries

The types of head injuries are listed below:

• Skull fracture- during this skull fracture, there is a break in the skull bone. There are four types of skull fractures. They are:

1. Basilar skull fracture- as the name suggests, there is a fracture at the base of the skull bone. It is the most serious type of skull fracture. These patients usually require a hospital stay for close observation. Patients usually complain of clear fluid discharge from the nose or ears.
2. Linear skull fracture- during this fracture, there is a crack in the bone of the skull, but it does not move the bone. It is one of the most common types of skull fracture. These fractures usually do not require any intervention. However, the patient should be kept in the hospital for observation.
3. Diastatic skull fracture- during this fracture, there is a crack along the suture lines of the skull. Suture lines are the area found between the bones in the head that fuses during childhood. Diastatic skull fractures are more often seen in newborn and older infants.
4. Depressed skull fracture- during this fracture, fractures can be seen with or without a cut in the scalp. Depressed skull fractures usually require surgical intervention in order to correct the deformity.

• Concussion- during this condition, there is an injury to the head region that may cause instant loss of consciousness or alertness for a duration of a few minutes or a few hours after the traumatic event.
• Intracranial hematoma- there are various types of intracranial hematomas present. Based on their location, they are classified and named. They are listed below:

1. Contusion or intracerebral hematoma- during this injury, there is a bruise to the brain. A contusion often causes bleeding and swelling inside the brain around the area where the head was injured.
2. Subdural hematoma- it is a condition where a blood clot is formed beneath the skull and beneath the dura, outside the brain. Subdural hematoma is caused due to tear in the vein of the brain that supplies the dura.
3. Epidural hematoma- it is a condition where a blood clot is formed beneath the skull, but above the dura, outside the brain. Epidural hematomas are often formed due to a tear in the middle meningeal artery (the artery that runs under the skull).
4. Diffuse axonal injury 

Causes of head injury

The most common causes of head injury are listed below:

• Acts of violence- physical abuse
• Road traffic accident (RTA)
• Child abuse
• Fall from height
• Bleeding disorders
• Head injury while playing football, cricket, cycling, soccer, and other playground activities
• Long-term high blood pressure
• Patients who are on blood thinners or certain recreational drugs
• Explosive blasts and other collusive injuries.

Risk factors of head injury

The risk factors associated with head injury are listed below:

• Children who are newborn to 4 years old
• Adult age group > 60 years and older
• Young adults, aged between 15 and 24 years
• Males in any age group

Symptoms of head injury

The symptoms of head injury vary from person to person. The symptoms depend upon the severity of the condition. The symptoms of head injury are listed below:

Children’s Symptoms

• Drowsiness
• Seizures
• Easy irritability
• Persistent crying
• Inability to be consoled
• Change in eating habits
• Loss of interest in playing with their favorite toys and games
• Change in ability to pay attention
• Change in sleep habits

Mild traumatic brain injury

• Physical symptoms
• Nausea and vomiting
• Headache
• Problems with speech
• Drowsiness
• Fatigue
• Loss of balance
• Dizziness

Sensory symptoms

• Sensitivity to light and sound
• Sensory problems which include blurring of vision, loss of taste buds, hearing aid, and change in the ability to smell.

Cognitive, behavioral, or mental symptoms

• Difficulty in sleeping
• Long-term sleeping
• Loss of consciousness for a duration of a few seconds or minutes
• Memory or concentration problems
• Mood changes or mood swings
• Confused or disoriented state of mind
• Depressed or anxious state.

Moderate to severe traumatic brain injury

• Physical symptoms
• Loss of consciousness for a duration of a few minutes or a few hours
• Seizures or convulsions
• Loss of coordination
• Recurrent episodes of vomiting or nausea
• Persistent headache
• Dilatation of one or two pupils of the eyes
• Clear fluid draining from the ears and nose
• Numbness in fingers and toes
• Fatigue
• Cognitive, behavioral, or mental symptoms
• Slurred speech
• Profound confusion
• Disorders of confusion
• Coma
• Agitation or other unusual behavior

Diagnosis of head injury

When the patient attains a head injury, the patient should be taken to the hospital immediately. Head injury is often a serious condition that must be diagnosed and treated as early as possible. The doctor initially will examine the patient thoroughly. The doctor in order to know the severity of the condition, the doctor will do a couple of tests. They are listed below:

• Physical examination- during the physical examination, the doctor initially will check if the patient is conscious, oriented, or not. The doctor will check the vitals of the patient (pulse rate, blood pressure, oxygen saturation, ECG, etc.), and any external injury to the patient.
• The Glasgow Coma Scale- it is mostly used to assess the severity of brain damage followed by head injury. It includes:

1. Eyes-

• Opens spontaneously- score 4
• Opens to oral command- score 3
• Opens to painful response- score 2
• Does not open eyes- score 1

2. Verbal response-

• Oriented to time, place, and person- score 5
• Oriented but confused- score 4
• Inappropriate words- score 3
• Incomprehensible words- score 2
• No response- score 1

3. Motor response-

• Obeys to oral commands- score
• Localizes pain- score 5
• Withdraws due to pain- score 4
• Flexion response to pain- score 3
• Extension response to pain- score 2
• No motor response- score 1

All these scores will be added together and the brain injury will be classified as follows:

• Mild injury- 13 and above
• Moderate injury- 9-12
• Severe injury- 3-8 [4].
• Laboratory tests- they include complete blood count, renal function test, urinalysis, liver function test, BT, CT, aPTT, etc.
• Investigational scans- they include a CT scan of the brain and an MRI scan of the brain. They will help us to locate the site of injury, the severity of the brain injury, and any hematoma collection in the brain.
• Intracranial pressure monitor- traumatic brain injury usually causes an increase in intracranial pressure which will cause more damage to the brain.
• Electroencephalography- it will help us to monitor the electrical activity of the brain
• Neurocognitive test- it will help us to evaluate the thought process and memory of the brain.
• Angiography- it will help us to detect if there is any blood vessel damage due to head injury

Treatment for head injury

The treatment for the head injury depends upon the type and severity of the head injury. The treatment options include:

• Mild head injury- mild head injury often does not any treatment. The patient will be advised to take rest and the doctor might prescribe painkillers for headaches or minor injuries if present. However, the patient is advised to have a close watch on his/her condition and have a regular follow-up with the doctor.
• Moderate to severe head injury- these patients require medical and surgical interventions. The treatment plans include:

1. Immediate emergency care- patient with moderate to severe head injury might require immediate emergency care.
2. Medications- medications that are advised to the patient after head injury are:

• Diuretics- diuretics are advised to the patient in order to minimize the intracranial pressure on the brain due to fluid accumulation.
• Pain killers
• Anti-seizure medications- there is a possibility that people who had moderate to severe brain injury develop seizures during their first week after the injury.
• Coma-inducing drugs- doctors might sometimes use drugs to put the patient in a coma state on a temporary basis so that the brain will take less oxygen to function in a coma state.

3. Surgery- surgical intervention might be required for the patients in order to minimize the risk of additional damage to the brain. There are various forms of surgical procedures done for head injury patients.
4. Rehabilitation- rehabilitation might be required for patients who had significant brain injury. The type and duration of rehabilitation required for the patient varies from person to person. It depends on the severity and overall condition of the patient.

Complications associated with a head injury

The complications that are associated with head injury are:

• Loss of consciousness
• Bleeding
• Irreversible brain damage
• Hydrocephalus (accumulation of fluid in the brain)
• Seizures
• Severe headache
• Blood vessels rupture and damage
• Infections
• Hearing loss or loss of vision
• Loss of sensation in the face (facial muscle paralysis)
• Vertigo

Prevention of head injury

The risks of head injury can be minimized or prevented by following the below-mentioned measures strictly. They are listed below:

• Avoid driving after alcohol or drug intake
• Wear a seat belt while driving a car and a helmet while riding a two-wheeler
• Pay attention to the surrounding while walking on the road, riding a bike, or driving a car
• Take safety measures while playing on the ground
• Maintain the blood pressure levels
• Older people should use hand grip bars in the bathroom
• Use non-slip mats on wet floors
• Child-proofing for children at home or in the play area
• Get periodic vision testing done at an older age, in order to avoid accidents due to blurring of vision

Prognosis of head injury

The outcome of the patient depends upon various factors which include the type of head injury the patient has undergone, the severity of the condition, the age of the patient, and overall, the condition of the patient. Most of the patients who had minor head injuries recover completely, whereas patients who had moderate to severe brain injury might require time to recover completely if diagnosed and treated at an early stage and if left untreated or delayed in treatment might cause death of the patient.

References

1. "Head Injury"  Hopkins medicine     
2. "Head Injury"  WebMD
3. "Traumatic brain injury" mayoclinic
4. https://www.researchgate.net/figure/Glasgow-coma-scale_tbl1_312924320
5. "Causes and effects of traumatic brain injury (TBI)"  Medical News Today   
6. "Head Injury In Adults" health.harvard.edu