Neuro Trauma

Head Injury:

What is Head Injury?

It is any sort of injury to brain, skull and scalp. This can range from a mild bump or bruise to severe head injury. Common are concussions, skull fractures and scalp wounds. Head injuries may be closed or open. A closed head injury is one when the scalp is intact. The scalp breaks open in an open head injury. It is hard to assess how serious a head injury is just by looking. Hence it is important to consider all head injuries as serious and get them assessed by a doctor.

Head injuries may be divided into two categories, one due to blows and one due to shaking. The ones, which manifest after shaking is commonly seen in infants and small children. The ones following blows are those associated with motor vehicle accidents, falls, physical assaults and sports related injuries. In some unfortunate situations head injuries are also associated with injuries to spine.

What are the major types of head injuries?

Hematoma: It is a collection of blood outside the blood vessels. It can be very serious if it happens in the brain. This leads to pressure building in the brain leading to unconsciousness, permanent brain damage or death. Sometimes there may be bleeding in the space around the brain called sub arachnoid hemorrhage.

Concussion: There will be sudden loss of function with complete recovery. This loss of function may last for some hours at times. Repeated concussions can lead to permanent damage. The famous example is international boxing legend Mohammad Ali.

Edema: Sometimes head injuries can lead to edema or brain swelling. This swelling is dangerous in the brain since it will lead pressure build up because the skull cannot stretch to accommodate the swelling.

Skull fracture: A skull fracture is any break in the cranial bones. The impact should be strong enough to break the bone. It can be associated with injury to the underlying brain.

Diffuse axonal injury: It is a shear injury. It causes severe brain damage with out any bleeding. The affected brain cells swell causing more damage. This leads to permanent brain damage and death.

What are the symptoms of head injury?

Symptoms of minor head injury

• Headaches
• Light-headedness
• Spinning sensation
• Confusion
• Nausea
• Ringing in the ears
• Symptoms of severe head injury
• Loss of consciousness
• Seizure
• Vomiting
• Disorientation
• Abnormal eye movements
• Persistent or worsening head ache
• Memory loss
• Leaking of clear fluid from ear or nose
• Loss of muscle control or paralysis

When does one need medical attention?

Medical attention should be sought if there is

• Loss of consciousness
• Confusion and disorientation

How is it diagnosed?

• Clinical examination using a coma score (lesser the score, severe the head injury)
• Imaging with CT scan to see for fractures, brain swelling, bleeding and clots in the brain.

How is it treated?

• Every head injured patient should be admitted and kept under observation at least for 24 hours
• Minor head injuries may not need any medication
• Severe head injuries will need anti seizure medications, medications to reduce the brain swelling and adequate oxygenation.
• Some times surgery may be required to remove the blood clot, repair the broken skull and to release the pressure in the brain
• All severely head injured patients require good rehabilitation for regaining mobility and speech.

What are the long-term outcomes?

The outcome depends on the severity of the injury. Seriously head injured patients may face permanent changes in their personality, memory and physical abilities.

Burden of Head injuries:

The burden is presented as number of deaths and injuries with the cost calculated by the expense of ongoing care. What are not considered are the psychological consequences and hidden costs such as inability to work, dis inhibition (aggressive and agitated) and altered mood status. Many of the people enter a down ward spiral associated with altered behavior, alcohol and further head injuries. Traumatic brain injury is a disease that affects the poorer and more vulnerable members of the society and leads to a cycle of yet further vulnerability

How can one prevent Head injuries?

• Always one should wear seat belt or helmet when driving
• One should follow traffic rules and adhere to speed limits
• One should never drive under the influence of alcohol
• Spinal Trauma

Spinal cord injury (SCI): What is it?

Spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. This spinal cord runs inside the vertebral column, a series of bones lined one above the other. SCI is due to bruising, partial or complete tears in the spinal cord following trauma.

What causes SCI?

• Falls
• Motor vehicle accidents
• Sports injuries
• Diving accidents
• Violence

What are the symptoms?

The location of the injury on the spinal cord determines the symptoms. The higher the level of injury, the more severe the symptoms. Lower level injuries affect only the nerves and not the spinal cord and hence are less severe.

Common symptoms are

• Muscle weakness
• Breathing problems
• Loss of sensations
• Loss of bladder and bowel symptoms

How are they diagnosed?

• Good clinical examination and imaging
• X rays, CT scans and MRI all aid in pin pointing the level and extent of the injury.

How are they treated?

SCI needs emergency medical attention at the site of the accident. The patient needs to be immobilized to prevent movements. The primary damage cannot be undone and whatever treatment is done is only to prevent secondary damage. Physiotherapy and rehabilitation play an important role. On the whole treatment entails a multi disciplinary approach.

How can SCI be prevented?

• One should not drive under the influence of alcohol or drugs.
• One should always wear a seat belt in a vehicle
• Adequate precautions should be taken to prevent falls

Living with spinal cord injury:

SCI is devastating to both the patient and to the family. It requires long-term hospitalization and rehabilitation. Occupational therapy also plays an important role. The patient may get depressed and need psychotherapy also. The financial burden on the family would be huge.

Authored By Dr. Sai Sudarsan