Head injuries: What you need to know; when to be concerned

Head injuries happen, but when does a simple knock on the noggin turn into something you have to be worried about?

What is a head injury?

The first thing you need to know is what exactly is a head injury.

Head injuries can range in severity, according to Johns Hopkins. It can be something as simple as a bump or bruise, a cut, a concussion or a fractured skull.

A head injury can also result in internal damage or bleeding that the person may not realize they are experiencing.

A head injury can involve the scalp, skull, brain and underlying tissue or blood vessels.

More and more people are having injuries to their heads every year, with approximately 1.7 million people having a traumatic brain injury — also known as a TBI — annually, according to Johns Hopkins.

Types of head injuries

There are different types of head injuries.

A concussion is an injury to the head that can cause a loss of alertness immediately for a few minutes to a few hours after the incident.

Skull fractures are exactly what they sound like — a break in the skull bone.

There are four types of skull fractures.

A linear skull fracture is the most common and it’s a break in the bone but the bone is not moved. Such a fracture is treated with observation in a hospital and normal activities can resume usually in a few days.

A depressed skull fracture can happen with or without a scalp cut. The skull is actually depressed from the injury and it could need surgery to repair it.

A diastatic skull fracture happens along the suture lines between the skull plates that will fuse in children. When a suture line is fractured, the lines widen. They are most often seen in newborns and infants.

A basilar skull fracture is the most serious. This is a break that happens in the base of the skull. People who have a basilar skull fracture may have bruises around their eyes and behind their ears. They may have clear fluid leaking from their nose or ears. They usually need to be closely observed in a hospital.

In addition to skull fractures, there are other injuries that can happen. An intracranial hematoma, or ICH, is a blood clot in or around the brain. This can be mild, serious, or life-threatening.

An epidural hematoma is an ICH that is found under the skull but on top of the dura or the covering of the brain. It comes from an artery tear and is associated with a skull fracture.

A subdural hematoma happens under the skull and dura, but outside of the brain. It can be caused by a cut to either a vein or the brain. It can be, but is not always associated with a skull fracture.

A contusion is a bruise to the brain. Bleeding and swelling in the brain can happen when there’s a skull fracture or a blood clot. It can also happen without a traumatic event.

A diffuse axonal injury is common and is caused when the brain is shaken. It can happen in a car accident, fall, or in cases of shaken babies. It can be mild like a concussion or can be severe, which can result in a coma and injuries to different parts of the brain.

Causes

Brain injuries can be caused by a variety of events, from a simple fall to a vehicle accident. They can also be the result of a violent event, sports injury or an explosion or other combat-related incident, according to the Mayo Clinic.

Symptoms

Symptoms of brain injuries can vary depending on how the type and severity of the injury.

They can be mild like a bump, bruise, headache and grow more severe — for instance, confusion, irritability, dizziness, blurred vision and feeling lethargic or tired, according to Johns Hopkins.

Moderate to severe head injuries can have the same mild symptoms but also bring loss of consciousness, a severe headache that does not go away, slurred speech, loss of short-term memory, weakness, difficulty walking, pale skin, seizures, unequal pupils, behavior change and coma.

There could also be visual disturbances, the “Today” show reported.

The Mayo Clinic said there can also be ringing in your ears, a bad taste in your mouth and changes in your sense of smell.

Johns Hopkins said that some symptoms of a head injury are similar to other conditions so a person should consult a doctor.

For children, the symptoms may be a bit different. Parents should watch for changes in eating or nursing habits, unusual irritability, constant crying and an inability to be consoled, lack of attention, different sleep habits, loss of interest, sadness or depression and sleepiness, according to the Mayo Clinic.

Some symptoms may happen right after the injury, like a headache or confusion but don’t be fooled. It could be an initial “lucid period,” NBC news medical correspondent Dr. John Torres said.

“Typically they [patients] can hit their head ... and then they have what‘s called a lucid period. Initially, they have a few symptoms, usually a headache, maybe vision disturbances, maybe a bit of confusion, then they have a lucid period that can be minutes or hours where they feel like they’re normal.”

But it is what happens later that can be cause for concern.

“Then they start coming back with these heavy symptoms, and that’s when they usually end up having issues like this, and unfortunately in cases like this, they can die from it,” Torres explained.

Normally the injuries are caused by a hard hit caused by a fall or car accident, not whacking your head on a cabinet door, Torres said. But if you do hit your head and you’re concerned, especially if you’re having symptoms, Torres said you could consult a doctor.

In some cases, you may need to get to a hospital in a relatively short time after the injury occurred and once you see symptoms, Dr. Sanjay Gupta said in CNN. This is so pressure can be removed from the brain since it has “nowhere to go” as it is encased in bone.

Diagnosis

A variety of tests may be used to diagnose a head injury, including blood tests; X-rays; computerized tomography, or CT scan; an electroencephalogram or EEG; or magnetic resonance imaging, also known as an MRI, according to Johns Hopkins.

“They’re probably going to need a CAT scan of their head to make sure there isn’t any bleeding inside there,” Dr. John Torres told “Today.” “Because there can be subtle signs that build up over time and get to the point where they can’t really be taken care of.”

Treatment

Treatment will depend on the age of the person who was hurt, the extent and type of injury and tolerance for treatment. The treatment can be something as simple as ice on the injury and rest; observation at home or in a hospital; sedation; being put on a ventilator or respirator; or surgery.

Post-injury issues

Once the injury itself is healed, there could be long-lasting effects in some cases.

According to the Mayo Clinic, the conditions could include cognitive problems, executive functioning problems, communication problems, issues with social skills, behavioral changes, emotional changes and sensory problems.

There can also be some degenerative brain disease that was caused by a brain injury.