Head Injuries Overview

Head Injury Definition

• A head injury is a broad term encompassing a range of injuries to the scalp, skull, brain, and associated tissues and blood vessels.
• It can be classified as blunt or penetrating trauma to the head (above the neck) and/or brain caused by external force, resulting in temporary or permanent impairment of brain function, potentially causing structural changes.

Types of Head Injuries

• Concussion: A mild traumatic brain injury (TBI) caused by a blow or violent shaking to the head. It's thought to result from the brain striking the skull or from rapid acceleration/deceleration forces. Usually, the loss of function is temporary. Repeated concussions can cause permanent brain damage.
• Contusion: A brain bruise due to a direct impact. The associated loss of function is typically temporary but can become permanent with repeated injuries.
• Intracranial Hematoma (ICH): Blood clots (hematomas) located inside the brain. These are categorized by their position—epidural, subdural, or intracerebral. They can vary in severity, ranging from mild to life-threatening, potentially causing pressure buildup inside the skull, loss of consciousness (LOC), and permanent brain damage.

Skull Fracture Types

• Linear: The most common type, characterized by a break in the bone without significant bone displacement. Usually resolves without intervention.
• Depressed: The skull is fractured and compressed inward. May or may not involve a scalp laceration. Usually requires surgical intervention to correct the deformity.
• Diastatic: Fractures along the suture lines of the skull, where the bones fuse during childhood. Often seen in newborns and older infants, where sutures are not yet completely fused.
• Basilar: The most severe type, involving a break in the skull base. Often associated with bruising around the eyes and behind the ears, and potential fluid leakage (from the nose or ears) due to the tear in the protective covering of the brain. Requires close observation.

Diffuse Axonal Injury (DAI)

• A fairly common injury caused by rapid, back-and-forth movement of the brain, such as in car accidents, falls, or shaken baby syndrome.
• Can range from mild (e.g., concussion) to severe (e.g., coma) and affect multiple parts of the brain. Patients often remain in a coma for a prolonged period with injury to many parts of the brain.

Cerebral Edema

• Swelling of the brain tissues which can follow any brain injury.
• Particularly serious when occurring inside the skull, where space is limited, causing pressure buildup and potential damage to the brain.

Causes of Head Injury

• Motor vehicle accidents (most common)
• Violence/assault
• Falls
• Child abuse

Diagnostic Tests

• Physical Examination: Vital signs (BP, temperature, pulse, respiratory rate), observation for injuries (bruises, swelling, bleeding), neurological assessment (mental status, motor function, sensory function, coordination, reflexes).
• Imaging Tests: Computed Tomography (CT) scan (rapid, effective for acute injuries to detect fractures, bleeding, swelling, or other injuries; Magnetic Resonance Imaging (MRI) scan (more detailed than CT, useful for smaller injuries such as contusions or diffuse axonal injury for diagnosing long-term damage), Skull X-ray.
• Neurological Tests: Assessment of cognitive function (memory, attention, problem-solving, language skills) to understand cognitive impairment and plan rehabilitation.
• Blood Tests: Blood group and cross-match (BGXM), bleeding time, prothrombin time, hemoglobin (Hb%).
• Intracranial Pressure (ICP) Monitoring: Placing a sensor within the skull to measure pressure. Useful in severe head injuries to guide treatment.
• Glasgow Coma Scale (GCS): Assessing level of consciousness. Measured by evaluating eye opening, verbal response, and motor response.

Sign & Symptoms of Brain Injury (mild, moderate, severe)

• Physical symptoms: headache, nausea, vomiting, fatigue, drowsiness, problems with speech, balance.
• Cognitive symptoms: loss of consciousness, confusion, disorientation, memory problems, difficulty concentrating.
• Emotional changes: Mood fluctuations, anxiety, or depression.

Red Flag Signs (serious symptoms)

• Impaired consciousness level
• Pupils that don't react to light ("fixed and dilated," potentially one or both sides)
• Symptoms of a basal skull fracture, such as leakage of fluid from the nose or ears.
• Focal neurological deficits (weakness, numbness, paralysis on one side of the body, etc.)
• Seizures or amnesia
• Severe headache associated with nausea and/or vomiting.
• Associated with cervical or spinal injury.

Management (Emergency Department)

• Perform primary (ABCD) and secondary surveys

• Stabilize the patient

• Maintain airway and breathing.

• Administer supplemental oxygen.

• Monitor vital signs.

• Assess neurological function (GCS, AVPU)

• Treat secondary brain injuries.

• Imaging tests (CT/MRI)

• Fluid and electrolyte balance

• IV Fluids

• Medication to support the brain

• Management of associated injuries.

• Prepare for potential surgery (craniotomy).

• Apply a cervical collar if necessary

• Manage any external bleeding.

• Set an IV infusion (IV) to maintain hydration and blood pressure, potentially dexrose 5%/10%

• Monitor Intake and Output (I&O) and administer fluids/diuretics appropriately.

• Consult with appropriate specialists.

• Observation, monitoring, and follow-up care.

This quiz covers the definition and types of head injuries, including concussions, contusions, and intracranial hematomas. Learn about the implications of these injuries and how they affect brain function. Test your knowledge on the various classifications and characteristics of head injuries.