traumatology

Head trauma

Generality

From a medical point of view, any damage to the skull and / or the encephalon and its sheaths is defined as "head trauma", caused by a mechanical physical event (such as, for example, a fall into which the head to the ground).

Head trauma is a condition that must not be underestimated. In fact, it is not certain that the symptoms or any damage resulting from the trauma in question will immediately manifest; on the contrary, in some cases they could appear even after hours, or even weeks after the damage occurred.

For this reason, in case of head trauma, it would always be advisable to consult your doctor.

Causes

As mentioned, the head injury is a damage to the skull and its contents, caused by a physical mechanical event.

More precisely, we can say that the head injury can be caused by:

  • A lesion closed to the head, when the head violently strikes an object, as can happen in case of falls, road accidents, violent quarrels, sports injuries, etc.
  • A penetrating injury to the head, when the head strikes, or is violently hit by an object that is able to penetrate it (such as, for example, bone fragments or bullets).

Classification

A first classification, which can be made to distinguish the different types of head trauma, takes into consideration the severity of the damage suffered. In this case, therefore, we will distinguish:

  • Mild cranial trauma ;
  • Moderate or severe head injuries .

As can be easily imagined, mild head injuries are in themselves less dangerous than moderate or severe ones and present a better prognosis; however, they must not be underestimated.

Another subdivision can be made according to the area affected by the damage. In this regard, we can distinguish:

  • Focal cranial trauma, when the damage affects only one particular area of ​​the brain;
  • Diffuse head injury, when the damage affects multiple brain areas.

Naturally, the symptomatology can vary both in function of the severity of the damage, both in function of the affected area.

Symptoms and Complications

As mentioned, the symptomatology of the head injury can be different depending on the extent of the damage and depending on the area of ​​the brain - or the brain areas - affected by the latter.

Furthermore, some symptoms appear soon after the damage has occurred, while others may take hours, days or even weeks before they occur.

However, among the main symptoms that can occur in the case of mild head injury, we recall:

  • Short-term loss of consciousness (a few seconds or a few minutes); however, it should be pointed out that this symptom does not always manifest itself;
  • Mild mental confusion (see also concussion);
  • Headache;
  • dizziness;
  • Neck pain;
  • Eye disorders (diplopia, feeling of tired eyes, etc.);
  • tinnitus;
  • Daytime sleepiness, lethargy and fatigue;
  • Difficulty concentrating.

In the case of moderate or severe head injury, on the other hand, the symptoms mentioned above can manifest themselves in a more marked and intense manner. More in detail, they can arise:

  • Loss of consciousness with the impossibility of awakening;
  • Persistent headache that worsens over time;
  • Focal neurological deficits;
  • Repeated vomiting;
  • Personality changes;
  • Confusion and agitation;
  • Mydriasis or paralysis of the pupils;
  • Difficulty communicating;
  • Disorders of coordination.

Furthermore, in the long term they could manifest themselves:

  • Amnesia;
  • Behavioral disorders;
  • Sleep disorders;
  • Alteration of intellectual faculties.

The symptoms related to the head injury can, depending on the case, regress, remain unchanged, or worsen.

When to call the doctor

Notwithstanding that in the event of head injuries it is always advisable to contact your doctor or the nearest hospital, this behavior becomes mandatory when the symptoms that appear after the damage tend to worsen. In fact, a worsening of the symptoms of head trauma could indicate the presence of deeper lesions or complications, such as, for example, cerebral edema or intracranial haemorrhages.

Other complications that may arise in patients with TBI are:

  • Seizures;
  • Ischemic stroke;
  • Hemorrhagic stroke;
  • Hydrocephalus.

Diagnosis

In addition to the evaluation of symptoms, to confirm the diagnosis of head trauma and to identify possible brain lesions, the doctor can use instrumental investigations such as CT or MRI.

The CT scan is usually able to identify possible cranial fractures with greater accuracy than other techniques, as well as providing indications on the presence of hemorrhages or hematomas; while the magnetic resonance allows the more precise and detailed identification of possible brain lesions.

X-rays, on the other hand, in most cases of head trauma are completely useless. Eventually, X-rays may be useful for detecting the presence of fractures in other sites of the body, which may have been caused by the fall or accident that gave rise to the head injury itself.

In the event of suspected or proven brain damage, the doctor may decide to hospitalize the patient.

Treatment

The treatment of head trauma is closely related to the extent of damage suffered by the patient.

If the head injury is mild and the patient has a family member or in any case people who can watch over him and keep him under control to identify the appearance of further symptoms, then the doctor may decide not to admit him.

If, on the other hand, the head injury is moderate or severe and is associated with brain injury, of course, the doctor will immediately provide hospitalization for the patient.

Treatment of mild head injury

If the patient has suffered a mild head injury and the main symptom that manifests is pain located in the affected area, the doctor may decide to prescribe the administration of paracetamol, so as to induce analgesia and give relief to the patient.

Usually, it is preferred to avoid the administration of acetylsalicylic acid or other NSAIDs, since these drugs have anticoagulant activity and could worsen any undiagnosed cerebral haemorrhages, whose symptoms - as we have said - can occur even after some time from the damage .

Normally, patients who have undergone a mild head injury are checked at regular intervals during the 24 hours following the trauma, in order to promptly identify - therefore, so as to intervene just as quickly - in the event that additional symptoms appear or in the event that those already manifested become worse.

Treatment of moderate or severe head injury

In the case of moderate or severe head injury, hospitalization is a must. Moreover, in this situation, for the transport of the patient to the hospital center, it is necessary to contact the medical helpers, who will immediately take care of detecting all the vital parameters of the patient, assessing his degree of consciousness and possibly immobilizing his head, the neck and the spine in a preventive measure.

Patients with moderate or severe head injury can be given medication for pressure control (such as, for example, diuretics), painkillers and possibly sedatives. Furthermore, the doctor may also decide to undertake a symptomatic treatment aimed at counteracting some of the symptoms resulting from the trauma, such as fever and vomiting.

In very serious cases, patients with head trauma can be admitted to the intensive care unit, where their vital parameters will be constantly monitored and where they will be subjected to artificial respiration.

In some cases, in addition, the doctor may consider it necessary to intervene on patients suffering from head trauma with surgery, in order to remedy any bruises, bruises or bleeding that may have formed.