Head Injury

Head injuries are some of the most devastating injuries that can happen during a motor vehicle accident, fall or sports injury. This is because head injuries often damage brain cells which do not easily recover from an injury and permanent disability is the result.

Table of Contents

• What is a Head Injury?
• Symptoms of a Head Injury
• Symptoms of a Concussion
• Symptoms of a Brain Contusion
• Symptoms of a Brain Hematoma
• Symptoms of a Skull Fracture
• Causes of a Brain Injury
• Diagnosis of  Brain Injury
• Treatment of a Brain Injury
• Complications of a Brain Injury

There is a wide spectrum of head injuries, from a mild concussion to those injuries resulting in coma and death. Head injuries do not necessarily have to involve the brain.

It can be an injury to the scalp, as in a laceration to the scalp, a skull fracture, or to the brain itself. The most common type of sports injury related to the brain is the concussion, which affects up to 3.8 million athletes per year.

Among average people, about 1.5 million individuals suffer some kind of brain injury every year. About 5.3 million individuals at a time are suffering from the long-lasting effects of brain damage. Of these, 50,000 people die because of their brain trauma with medical costs and costs due to lost productivity being $48-$60 billion USD per year.

A concussion is a type of brain injury in which the brain is struck against the skull because the brain is smaller than the skull cavity and it bounces against the interior walls.

Other types of brain injury include a contusion. This is a bruising of the brain that can swell the brain and cause changes in mentation. Contusions are considered more severe than concussions. There are also hematomas that are collections of bleeding within the brain or just outside the brain. Depending on the site of the bleeding and the speed of the bleeding, a hematoma can quickly swell the brain, leading to herniation of part of the brain into the foramen magnum at the base of the skull, leading to death.

A skull fracture is another type of head injury. It can occur with a penetrating injury to the skull or a strong blunt force trauma to the skull. The skull fracture can be linear and not cause much damage. It can also be comminuted or depressed, with fragments of bone-cutting into brain matter, leading to brain damage.

The symptoms of a brain injury depend on the type of injury a person has. The symptoms, for example, of a concussion are different from the symptoms of a brain hematoma, although some symptoms overlap. It’s important to remember that symptoms of a head injury don’t have to occur at the time of the trauma. Symptoms can occur days or weeks following the head trauma.

• Brief loss of consciousness
• Headache
• Feeling as if in a fog
• Confusion
• Lack of memory of the event
• The ringing of the ears
• Dizziness
• Nausea and/or vomiting
• Difficulty speaking
• Tiredness
• Difficulty with memory or concentration
• Personality changes like irritability
• Sleep difficulties
• Sensitivity to sounds and bright light
• Depression or adjustment difficulties
• Problems with smell and taste

The symptoms can be transient over the course of a few hours, while some can last for weeks or even months, depending on the degree of brain trauma.

These symptoms can come on sooner than a concussion and tend to be more severe in nature:

• Nausea and vomiting
• Weakness in an arm or leg
• Dizziness
• Enlarged pupil
• Restlessness, irritability or agitation
• Memory loss
• Drowsiness or confusion (goes along with brain swelling)
• Loss of consciousness
• Fainting

If there is prolonged loss of consciousness or pupillary differences, a doctor or emergency room should be contacted immediately.

These tend to come on fairly quickly as the hematoma builds up with the skull cavity but some hematomas caused by broken veins take longer to develop.

• Sudden onset of a severe headache
• Seizures of a new-onset
• Nausea and/or vomiting
• Weakness in an arm or leg
• Lethargy
• Tingling or numbness in a body area
• Alterations in vision
• Difficulty with speech
• Difficulty with reading and writing
• Difficulty swallowing
• Loss of normal fine motor skills
• Loss of balance and coordination
• Loss of consciousness
• Abnormal sense of taste

The greatest risk with hematomas is brain swelling which can lead to herniation and sudden death.

A skull fracture may simply be painful without other symptoms or it can involve symptoms related to the brain itself. Here are some common symptoms:

• Scalp swelling
• Headache
• Scalp tenderness
• Scalp laceration or abrasion
• A puncture wound in the scalp
• Deformed skull, such as in a depressed skull fracture

If the skull fracture is serious and affects the brain, the symptoms become more severe and include:

• Ringing in the ears
• Battle sign—bruising behind the ears
• Raccoon’s eyes—bruising around the eyes
• Blood behind the eardrum
• Discharge from the ear of the clear or bloody fluid
• Clear nasal drainage from a cerebrospinal fluid leak

Most brain injuries are of the blunt trauma type, while a few are from penetrating trauma due to gunshots and sometimes knives. The main causes of trauma to the brain include:

• Sports injuries, such as football, basketball, diving, or soccer
• Automobile accidents
• Motorcycle accidents
• ATV accidents
• Falls from a great height
• Altercations
• Penetrating injuries such as gunshot wounds
• Child abuse

A simple skull fracture can be diagnosed with a plain film x-ray. It can show the fracture in the bone but cannot tell whether or not the fracture has done any internal damage. For that, you need other diagnostics.

A CT scan is a form of x-ray that is manipulated by a computer to turn the images it sees into cross-sectional images that are read by the radiologist. The patient lies on a table while a large tube is passed over and around them. Sometimes contrast dye is used to get better pictures of the structures in the brain. It is a good test for picking up hemorrhages.

An MRI scan does not use x-rays but instead uses a strong magnet and radio waves to form an image that yields cross-sectional pictures similar to a CT scan. The MRI scanner looks a lot like a CT scanner except the tube is narrower and there is a loud machinery-like sound that happens when the MRI scanner is going. The MRI does a better job of picking up soft tissue details than the CT scanner.

No two brain injuries are alike. Some are more stable and others require emergency surgery to drain hematomas before the brain herniates. When the patient is stable but unconscious and not breathing on his or her own, they need to be in the intensive care unit with a ventilator to breath for them. Other things used to treat unconscious patients in an ICU include:

• IV fluids, which are usually kept to a minimum to keep the brain from swelling
• Arterial lines to measure oxygenation and blood pressure
• Foley catheter to drain urine from the bladder
• A nasogastric tube to keep acid out of the stomach
• EKG to monitor the heart
• Intracranial pressure monitor to check brain swelling
• Pulse oximetry, which externally monitors the body’s oxygen levels.

After the patient recovers consciousness and is weaned off the medical devices necessary to keep them alive, they begin to recover. In acute rehabilitation, the person learns how to function on a day to day basis by learning the activities of daily living. They learn things like how to eat independently, how to dress oneself, toileting, how to walk, speaking and other activities that make up the day.

When the patient becomes well enough, he or she may be transferred to a post-acute rehabilitation facility or ward. There they strive for as much independence as they can get for life, for their job and for regaining relationships. This type of rehab channels the body’s normal healing powers and teaches the brain to learn what it needs to learn. Some eventually end up in day treatment to continue learning things that were lost at the time of the brain injury.

The video below explains how traumatic brain injuries are treated.

Brain injury can result in being in a persistent coma, being in a vegetative state or being in a minimally conscious state. There is a locked-in syndrome in which the patient has a brainstem injury that prevents a connection between their brain and their body. There can be seizures that last indefinitely and fluid buildup in the brain that causes brain swelling. Certain wounds can result in infections of the brain and there can be blood vessel damage that leads to strokes in the brain.

Damage to the cranial nerves in the brainstem can cause the following:

• Damage to the muscles of eye movement
• Paralysis of facial muscles
• Loss of vision
• Loss of sense of smell
• Loss of facial sensation
• Swallowing difficulty

There can be cognitive difficulties, communication symptoms, behavioral changes, emotional changes, or degenerative brain conditions.

I’m Ed Smith, a Sacramento Traumatic Brain Injury Lawyer. If you or a loved one has suffered a head injury as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 or 800.404.5400 for free, friendly advice.

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Photo by DepositPhotos.com

Editor’s Note: This page has been updated for accuracy and relevancy [cha 1.2.20]