Closed Head Injury

Closed Head Injury
A closed head injury is a type of traumatic injury to the brain.  In these cases, the dura mater and the skull remain intact and only the brain is injured.  Statistically, closed head injuries represent the leading cause of death in kids under four years old and are the leading cause of cognitive impairment and physical disability in young persons. Closed head injuries and other types of mild traumatic injuries to the brain represent approximately 75 percent of the 17 million estimated brain damage cases that happen in the US annually.  Closed head injuries can cause lifelong cognitive, physical and psychological impairment so it is an important public health issue.

Closed head injuries are generally more severe than open head injuries.  The skull is intact but the brain has suffered a bumping against the skull and is injured.  It can be caused by a slip and fall injury, an automobile crash or a blow to the head in sports or from an attacker.  Occupational incidents can cause a closed head trauma.  When the brain is thrown against the skull, the brain’s nerves are damaged and they can’t send the signals they are supposed to send.  Whatever those nerves were supposed to do doesn’t get done and there is a mental deficit.

The brain will swell after a closed head trauma and there will be pressure on brain cells that can’t expand properly.  These nerves get compressed and damaged. Sometimes brain tissue pushes against the eye sockets and the functions of the eye get damaged.

Falls are common, accounting for 35 percent of closed head injuries in the US.  The rates are highest for kids aged 0-4 and adults who are over 75 years.  Men get closed head injuries more than women and this is across all age groups.  Boys who are under 4 years old have the greatest rates of closed head trauma-related hospitalizations, hospital visits and deaths.  Sports players often have multiple mild closed head injuries over a short period of time; this can lead to significant long term neurologic or cognitive defects.  Closed head injuries can be fatal.
In the military, blast-related traumas to the brain are common.  These closed head injuries result from changes in atmospheric pressure that occur suddenly or by objects from the blast hitting people or by being tossed into motion because of the blast.  There has been an increase in these types of injuries since the recent wars, beginning in the 1990s.

Closed head injuries can be "mild”, such as concussions, or they can be debilitating brain injuries, leading to severe injury to the brain and possibly death.

Types of Closed Head Injuries
Closed head injuries range from  "mild"  to very severe.  The mildest form of closed head injury is the concussion.  This is a head injury that causes a temporary dysfunction of the normal functioning of the brain.   Approximately half of the total number of concussions found each year in the US happens because of sports.
Another type of closed head injury is called an intracranial hematoma.  This results from blood vessels rupturing around the brain so that blood pools, causing an epidural hematoma or a subdural hematoma.  An epidural hematoma is caused by blood between the brain and the skull and the subdural hematoma is a pool of blood around the brain itself.

A cerebral contusion is an actual bruising to the tissue of the brain due to trauma.  Unlike concussions, contusions are localized to a section of the brain, yielding focal neurological findings.  Brain contusions do not heal but eventually form a scar.
A very severe closed head injury is called a diffuse axonal injury.  These injuries are more often seen in automobile accidents and do damage to the axons of the nerve cell.  This type of injury causes permanent damage to the brain.  If the diffuse axonal injury is severe, it often leads to a deep coma or to a vegetative state.

Symptoms of a Closed Head Injury
Symptoms of a closed head injury are varied but may include dizziness, nausea, vomiting, sleep disturbance, loss of consciousness, headaches, emotional lability, confusion, dilated pupils, and possibly cerebrospinal fluid which may leak from the nose or ears.

If the symptoms of an acute head injury are seen shortly after an accident, then it is vital to get medical care to diagnose and treat the injury.  These types of injuries can become progressive and result in further brain damage, permanent disability and death.

Brain swelling from a closed head trauma can produce symptoms that slowly progress over time. Some symptoms do not surface for a couple of days to several weeks following the injury. The most common symptoms of a closed head injury include:
When a person gets a severe head injury, it can lead to permanent vegetation or death.  This means that it is vitally important to recognize those symptoms above that may represent a severe head injury so that medical attention can be received.

There are secondary symptoms in a closed head trauma that show up later, during the rehabilitation phase following the injury.  These include having an inability to properly socialize, being depressed, having personality changes, being anxious, having cognitive disabilities and changes in one’s sensory perception.  Records show that greater than 50 percent of patients who suffer from a closed head injury also suffer from a psychiatric illness after the injury.

One study of 60 patients found that about eight percent of patients subsequently developed a panic disorder, two percent developed an anxiety disorder and eight percent developed a phobic disorder.  Many patients in the recovery phase following a closed head injury will suffer from depression or low self-esteem.  There are often frustrations involved in rehabilitation and in re-entering society.  These are people who have elevated levels of unemployment which can result in having secondary symptoms.

Treatment of Closed Head Injury
There are multiple treatments for closed head injuries.  It all depends on how severe the injury is and the type of injury.  Treatment can be short or lifelong.  It is important to start treatment right away so as to avoid a continuing loss of motor function following an injury. Cognitive function, on the other hand, can be regained even after some time has passed since the injury.

Drug and medication therapy can be used to improve the symptoms of a closed head injury.  Anti-depressants such as fluoxetine and amitriptyline can be used to treat depression and help the patient function better in social and work settings.  DDAVP or desmopressin acetate is an antidiuretic.  It has been found to improve the memory of patients with closed head injury. Some studies have shown that progesterone has a preventative effect on injuries to the brain.  Initial studies have shown that there is a 50 percent reduction in deaths in patient who were treated with progesterone and the functional outcome is better than in patients not treated with progesterone.
Patient education is a great and effective method to lessen the secondary symptoms seen in closed head injury.  A therapist can be used to help the patient review their symptom management and begin to learn to return to "normal" life. Therapy and patient education have been identified as a way to improve PTSD symptoms in survivors of traumatic accidents.

Many patients who have severe head injuries need a therapist to help them regain cognitive and motor skills. If done correctly, this cognitive rehabilitation will improve memory, attention and the speed of cognitive processing.  Treatment is tailored to the patient’s specific needs and to the severity of the illness.
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