Millions of people suffer a closed head injury each year. While most of them are minor and do not need treatment, over half a million victims suffer a closed head injury of such severity that they are hospitalized for observation and treatment. A “closed head injury” means that you suffered a blow or other traumatic injury to the head, but your skull wasn’t broken or penetrated, such as by a knife or gunshot. A closed head injury, also called a blunt or nonpenetrating head injury, is a traumatic brain injury (TBI) that is not penetrating, that is, the skull and the dura mater are not breached and the brain is not exposed. 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 of the closed head symptoms listed below emerge.
A closed head injury can occur when the brain is suddenly and violently bounced against the skull from sudden acceleration or deceleration, such as when a passenger, properly wearing his or her seatbelt, in a vehicle going 65 suddenly crashes into the back of a stopped car, causing the passenger’s brain to suddenly hit 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 injuries that can be suffered in closed head injury are:
The most common causes of a closed head injury include traffic accidents, motorcycle and bicycle accidents, falls, physical assaults, and accidents at home (shaken baby syndrome is a example of a closed head injury), work, outdoors, or while playing sports. Some head injuries result in prolonged or non-reversible brain damage. This can occur due to bleeding or blood clots inside the brain or forces that damage the brain directly.
Some of the common injuries involved in a closed head injury include a 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; and a contusion, which is essentially a “bruise” on the brain. When there has been a closed head injury, the brain is susceptible to bleeding and blood clots. A number of conditions can occur, such as a subarachnoid hemorrhage, an epidural hematoma, and a subdural hematoma, resulting in blood leaking into the brain or its adjacent structures.
Bleeding and blood clots in the brain are serious conditions since the increase in intracranial pressure can cause damage to brain tissue and loss of brain function, even death. In some cases, it is necessary for the victim to undergo brain surgery to drain the bleeding or remove the clot.
The symptoms of a serious closed head injury include:
In all cases of injury to the head and neck, DO NOT move the victim’s neck and head unless absolutely necessary. Support the victim’s head in the position you found it. The bones of the spine (“vertebrae”) can be injured from movement of the head during trauma. Broken or displaced spinal bones can cut or put pressure on the nerves running through the middle of the vertebrae, which, if severed or pressured, can cause temporary or permanent paralysis and loss of feeing, resulting at its worst in quadriplegia or paraplegia, and even death.
The symptoms of a serious closed head injury usually show up immediately, while symptoms of a more 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 bang against the inside of the skull and be bruised. The head may look fine, but complications could result from bleeding or swelling inside the skull. Brain injuries can range from mild to severe. A closed head injury can be diffuse, meaning that it affects cells and tissues throughout the brain, or the closed head injury may be focal, in which case the damage affects only a limited area, such as the speech center. In all cases involving serious trauma to the head, you should always assume the spinal cord is injured and take the proper precautions.
Some types of closed head injury will usually go away fairly quickly on their own, such as a slight concussion. Other closed head injuries left untreated will continue to get worse until the victim dies, such as from an untreated blood clot or bleeding in the brain. The only way for certain to tell the difference between a slight closed head injury and a serious one is with a cranial computed axial tomography scan (a “CT scan”), which looks at the brain and the skull using x–rays. If you suspect a person has suffered a severe closed head injury, you should call 911 immediately so the paramedics can assess the person and arrange for an ambulance to take the person to the hospital immediately if necessary.
People with serious closed head injuries are almost always admitted to the hospital for observation and checked on regularly. Closed-head injury patients are usually given repeated studies to ensure that the victim’s condition has not worsened. Occasionally, a closed head injury may cause elevated blood pressure within the skull. An intracranial pressure (ICP) monitor may be surgically inserted into the brain through the skull to measure the pressure. If the pressure rises too high, it may be necessary to do surgery to relieve and to decompress the brain. Death is a possibility. Intravenous medications may be used to control intracranial pressure as a temporary measure until the crises resolves on its own or surgery is performed.
When there is a closed head injury with bleeding inside the skull, the doctor must consider a number of factors to determine the correct treatment. Some of the factors the doctor will consider include the location of the bleeding, the severity of the symptoms, the presence of any other injuries, and the progression of the symptoms. Surgery may be required in some cases to remove a blood clot or release pressure on the brain. Other options include pressure monitors, medications to prevent seizures, and antibiotics to prevent infection. People with this type of injury often need a breathing tube inserted to help prevent further brain damage (“intubation”).
Often the victim of a closed head injury can start vomiting, which can lead to problems with the victim’s airway. If the victim is unconscious, support his or her head, neck and back and roll them as a unit to put the person on his or her side to allow the vomit to drain from the victim’s mouth so the person does not get asphyxiated by his or her own vomit. Again, because of the possibility of damage to the spinal cord, roll the person to one side by turning his or her head, neck, and back as one unit.
For a moderate to severe head injury, take the following steps:
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.
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. The sleeping victim who has suffered a closed head injury should be woken 30 minutes after falling asleep to ensure that he or she can be aroused. If you cannot wake the victim of a closed head injury 30 minutes after he or she has been asleep, call 911 immediately if you haven’t done so already.
For a mild head injury, no specific treatment may be needed. However, you should watch the person for the next 24 hours to see whether he or she displays any conduct symptomatic of a head injury. It is suggested that the person, while sleeping, be awaken every two to three hours and asked 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, the child should be watched 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 naprosen (Aleve), as these can increase the risk of bleeding. NOTE THAT YOU SHOULD NEVER GIVE A CHID ASPIRIN BECAUSE OF THE RISK OF DEVELOPING A SERIOUS MEDICAL CONDITION CALLED REYE’S SYNDROME.
The degree and rate of recovery of a victim who suffers a closed head injury varies from person to person. The amount of time spent unconscious or in a coma, as well as how much of normal activity is recovered in the first month, are good indicators of long-term recovery.
Many closed head injuries are preventable if the person uses due care before engaging in the activity. For instance, wearing a seat belt will often save you from serious injury or death if you are involved in an automobile accident. Always wear a proper-fitting helmet during activities that could result in head injury, such as when operating or a passenger when operating or being a passenger on a motorcycle or bicycle. Helmets can prevent serious head injuries if you get into an accident. Children should be wearing an appropriate helmet when skateboarding, inline skating, or engaging in bicycle motocross. It may not be “cool” among his or her rebellious skateboarding and motocross buddies, but it is immensely more cool than falling off the skateboard or motocross cycle and sustaining a serious closed head injury that leaves the person in a persistent vegetative state. Bicyclists should obey all traffic rules and regulations, and at night they should wear bright, reflective clothing and equip their bikes with proper headlights and rear red flashers.