Hospital accident and emergency departments see a steady stream of people with head injuries. Most are found to have minor head injuries, and recovery is usually uncomplicated. However, some people will need medical care for a variety of reasons depending on the nature of their head injury and a very small proportion of these will have had a severe head injury that may require surgical treatment. Common causes of severe head injuries are road traffic accidents, falls and assault.
Features that would cause concern after a head injury are:
- Bad headache that gets worse or doesn’t go away within four to six hours after the injury occurred
- Drowsiness, if it lasts for more than two hours, or if the person is difficult to wake up
- Confusion and disorientation
- Feeling sick or actually vomiting is common following a head injury, but if it is persistent or appears to be getting worse, it could be serious
The doctor may order blood tests to see if there are any general medical problems or to check that the injured person’s blood will clot properly. X-rays may be needed to see if the skull has been fractured, or to see if there is any glass or metal in the wound if the skin is broken. In a number of cases a CT brain scan will be performed to see if there is any bleeding inside the head, or swelling of the brain.
A mixture of blood and fluid may accumulate on the surface of the brain several days or weeks after a relatively minor head injury. This is called a chronic subdural haematoma. This can cause pressure on the brain and a progressive worsening of symptoms such as headache, drowsiness, confusion, problems with speech or a weakness down one side of the body. Chronic subdural haematomas can be seen on a CT brain scan and are usually easy to treat by a simple drainage operation (via burr holes).
Many people attending casualty departments because of a head injury will have been knocked out. If this is the case, and they appear to have returned to normal afterward they are said to have been concussed. This means that for a short time the effects of the head injury were significant enough to stop the brain working properly and as a result they lost consciousness.
Whilst CT scans may fail to show up any abnormalities in such cases, there may be tiny areas of damage to the brain, which could have a major impact on recovery. Some people will not be able to return to school, college or work because of the effects of the concussion. Where concussion has occurred, doctors will usually classify the injury as moderate.
The following symptoms are common following concussion:
- Headaches that do not follow any particular pattern, though they may be worse towards the end of the day
- Loss of concentration with a poor attention span, such that the person loses track of conversations, films or books
- Loss of memory. After significant concussion people will usually be unable to recall the event and a period of time after it. They may also find that their memory for recent events is impaired.
- The person’s personality may be altered. Most commonly they may be more irritable or short-tempered
- There may be other specific problems, such as loss of sex drive, loss ofappetite, a general apathy or disinterest in life and a lack of self-esteem andself-confidence
If you have been involved in a head injury please contact your emergency department.
