Head injury after an accident? The symptoms are real, even when the scan looks normal.

Millions of people suffer a closed head injury each year. While most are minor and do not need treatment, over half a million closed head injury victims require hospitalization for observation and treatment.

A closed head injury is a blow or other traumatic injury to the head, that does not break or penetrate the skull or expose the dura mater or the brain. It may still, however, result in a traumatic brain injury.

Closed Head Injury Types

A closed head injury can occur when the brain bounces violently against the skull from sudden acceleration or deceleration, such as a high-speed automobile accident. During the collision, the passenger’s brain suddenly hits the skull. This intracranial impact causes the brain to swell, which quickly increases the pressure within the skull (“intracranial pressure”). The increased pressure causes more damage to the brain, which causes more swelling, which causes more injury, etc. Some of the more frequent and dangerous results from a closed head injury are:

• • Concussion: a violent jarring or shaking that results in a disturbance of brain function, and may occur when the head strikes or is struck by an object; a concussion may cause temporary loss of consciousness or bleeding in and around the brain
  • Brain contusion, or a “bruise” on the brain

• • Subarachnoid hemorrhage: a type of stroke caused by bleeding in the brain

• Epidural hematoma, or bleeding between the skull and dura mater
• Subdural hematoma, or bleeding outside the brain, which increases pressure on the brain
• Increased intracranial pressure: pressure inside the skull; this condition is a life-threatening medical emergency

The most common causes of a closed head injury include traffic accidents, motorcycle accidents, bicycle accidents, falls, physical assaults, and accidents at home, work, outdoors, or while playing sports. Some head injuries result in prolonged or non-reversible brain damage. This can occur due to direct damage to brain tissue, or from bleeding inside the brain.

When there has been a closed head injury, the brain is susceptible to bleeding and blood clots. The increase in intracranial pressure can damage brain tissue and cause loss of brain function, even death. In some cases, the victim must undergo brain surgery to drain the bleeding or remove the clot.

Symptoms of Closed Head Injury

A person who has been hit in the head should be watched for signs and symptoms of a closed head injury and seek immediate medical care if any symptoms listed below emerge:

• Loss of consciousness, either momentarily or for an extended time
• Inability to wake the victim
• The person stops breathing
• Changes in, dilated, or unequal pupils
• Short-term memory loss
• Nausea and vomiting, especially of the person vomits more than once
• Chronic headaches and/or a stiff neck
• Symptoms improve, then suddenly get worse (a change in consciousness)
• Restlessness, clumsiness, or lack of coordination
• Loss of change in sensation, hearing, vision, taste, or smell
• Dizziness
• Inability to move one or more limbs (paralysis)
• Seizures and convulsions
• Cerebrospinal fluid leaking from the mouth, ears, or nose (the fluid may be clear or bloody)
• Bruising of the face, swelling at the site of the injury, or a scalp wound
• Emotional, behavioral, and personality changes
• Irritability (especially in children)
• Slurred speech and other speech and language problems, or blurred vision
• Confusion
• High blood pressure
• Slow pulse

The symptoms of a serious closed head injury usually show up immediately, while symptoms of a mild case of closed head injury may take several days to weeks before they become apparent. Even if the skull is not fractured, the brain can swell inside of the skull or be bruised. The head may look fine, but complications could result.

What to Do If You Suspect a Closed Head Injury

For a moderate to severe head injury, take the following steps:

• Call 911.
• Check the person’s airway, breathing, and circulation. If necessary, begin CPR and rescue breathing.
• If the person’s breathing and heart rate are normal but the person is unconscious, treat the person as though he or she has suffered a spinal cord injury.
• Stabilize the victim’s head and neck by placing your hands on both sides of the person’s head, keeping the head in line with the spines and preventing movement. Wait for medical help.
• Stop any bleeding by pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person’s head. If blood soaks through the cloth, DO NOT remove it. Rather, place another cloth on top of it.
• If you suspect a skull fracture, DO NOT apply direct pressure to the bleeding site, and DO NOT remove any debris from the wound. Cover the wound with sterile gauze dressing.
• In any case of suspected injury to the head and neck, DO NOT move the victim’s neck and head. Support the victim’s head in the position you found it. Head movement during trauma can injure the bones of the vertebrae, which, if severed or pressured, can cause temporary or permanent paralysis, quadriplegia, paraplegia, or even death.
• If the person is vomiting, support his or her head, neck and back and roll them as one unit to put the person on his or her side to prevent choking.
• Children often vomit only once after a head injury. This may not be a problem, but you should call the doctor or paramedics for further guidance.
• Apply ice packs to swollen areas.

It is an old-wives’ tale that a victim of a closed head injury should not be allowed to sleep. If a victim of trauma to the head does not exhibit any of the signs or symptoms of a closed head injury, there is no need to keep him or her awake. However, wake the sleeping victim within 30 minutes after falling asleep to ensure that he or she regains consciousness. If you cannot wake the victim of a closed head injury, call 911 immediately.

A mild head injury may not need any specific treatment. Watch the person for the next 24 hours to see whether he or she displays any symptoms of head injury. You may try to awaken the person every two to three hours and ask a simple person, such as “What’s your name?”

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. Still, as with anyone who has suffered a head injury, watch the child closely for the next 24 hours.

Acetaminophen (Tylenol) may be given to the person for a mild headache.

Do not give aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve), as these can increase the risk of bleeding. NOTE THAT YOU SHOULD NEVER GIVE A CHILD ASPIRIN BECAUSE OF THE RISK OF DEVELOPING A SERIOUS MEDICAL CONDITION CALLED REYE’S SYNDROME.

Treatment for Closed Head Injury

Some types of closed head injury will heal quickly on their own, such as a slight concussion. Other closed head injuries, if left untreated, will continue to worsen until the victim dies, such as from an untreated blood clot or bleeding in the brain.

The only way to tell the difference is to have a CT scan (cranial computed axial tomography scan), which examines the brain and skull using x–rays. If you suspect a person has suffered a severe closed head injury, call 911 immediately so the paramedics can assess the person take him or her to the hospital immediately, if necessary.

People with serious closed head injuries are usually admitted to the hospital for observation. Occasionally, a closed head injury may cause elevated pressure within the skull. In that case, an intracranial pressure (ICP) monitor is surgically inserted into the brain to determine if surgery is necessary to relieve compression, or whether it can be controlled through medication.

Other medical options include medications to prevent seizures, antibiotics to prevent infection, or even intubation; people with this type of injury often need a breathing tube inserted to help prevent further brain damage.

The degree and rate of recovery of a victim who suffers a closed head injury varies. The amount of time spent unconscious, as well as how much of normal activity is recovered in the first month, are good indicators of long-term recovery.

Head Injury Prevention

• Many closed head injuries are preventable by using common sense and due care before engaging in risky activity. For instance:
• Always wear a seat belt in a car, even if you’re not moving (someone could hit you).
• Always wear a proper helmet for sports activities (such as football, skateboarding, or inline skating) bicycling, or riding a motorcycle.
• Use handrails on stairs and steps.
• Use a ladder or step stool to reach high objects.