Head Injury

HEAD INJURY

What is head injury?

Injury to the head involves the scalp, skull, or brain. Head injuries may be external or internal. Head injury is a major public health problem mostly affecting economically productive population.

What are the causes of head injuries?

Head injury commonly occurs due to road traffic accidents, fall from height and assaults.Head injuries can cause physical problems, cognitive (thinking) dysfunction, or emotional changes. Head injuries can be mild , moderate or severe. Severe head injury  can be life-threatening and mostly associated with permanent brain damage. Young children, teens, and the elderly are more often affected.

Common symptoms of head injury?

Head injury symptoms may occur right away, or hours or days later. Common symptoms  include one or more of the following effects: swelling and bleeding at the site of the injury , fracture of the skull, loss of consciousness, abnormal breathing, clear or bloody fluid discharge or leak from the nose, mouth, or ear, drowsiness, confusion, irritability, or loss of memory black color around the eyes, vomiting, changes in vision or speech, dizziness, headache or stiff neck,  and seizure. Sometimes, head injury may lead to behavior changes and psychiatric symptoms, especially in older patients.

How to diagnose head injury?

Medical examination include checking the person's ABCs (airway, breathing, and circulation), testing the person's alertness ( Glasgow coma scale), thorough clinical examination including any laceration, ear , nose or throat bleed, associated extracranial injury or weakness of the limbs.

Investigations:

Such as X-ray of the skull and cervical spine remove coma, remove full stop.  CT, or MRI are often done to check for brain damage. To rule out extracranial injury  some other investigations are required, like  chest x ray and x ray of the pelvis or lumbosacral spine, USG abdomen, CT scan of the abdomen. All the severe head injury patients should be screened for  cervical spine injury by x-ray cervical spine.

What are the treatment options for head injury?

Medical care starts with checking the person's ABCs (airway, breathing, and circulation). Any visible head injuries will be treated. A person with a mild head injury can be sent home after initial medical care. Someone must stay with the person and watch for serious symptoms over the next 24 hours. Instructions may include waking the patient every 2 to 3 hours to check for alertness. Get medical help if you cannot awaken or arouse the person.

In other head injuries, the treatment will depend on the severity. Hospital care may be needed for a period of time, and then rehabilitation care may be required.

Severe head injury may be fatal if not treated on urgent basis. Full stop timely intervention like immobilization of  neck, maintaining   airways, maintaining circulation and stopping the hemorrhage etc. may be life saving. Radiological investigation like CT scan and then neurosurgical care like evacuation of intracranial hematoma prevent the complication of head injuries. Neurosurgical intervention like cerebral decongestants and evacuation of hematoma prevent the brain shifts & reduce tertiary brain injuries. Long term follow up is needed for severely head injury patients.

Can head injury be prevented?

In Head injury cases prevention is better than cure & so public awareness programme and enforcement of legal actions can greatly reduce the incidence of severe head injury. Head injury  can be prevented by use of seat belts or wearing helmets during driving.. Use of helmets and seat belts while driving provide safety and significantly decreases mortality and morbidity. Don't drink or use mind-altering drugs and drive. Wear protective headgear when head injury is a risk. Place young children in approved safety car seats.

Mandatory speed limit for the vehicular traffic prevents injuries of the pedestrians and the drivers. Driving  after drinking alcohol is one of the causes of rash driving and injuries. Children should not be allowed to drive.Strict legal action against the drunk drivers, violator of traffic rules and mandatory provision for helmets and seat belts significantly reduces the incidence of head injury.

Majority of the severe head injury patients die because of lack of prompt medical care.Pre hospital care by the trained paramedical personnel concept golden hour and rapid transfer of patient to the trauma centre help to decrease the mortality during the early period of  severe head injury.

What are the Rehabilitation options for patients with  head injury?  

Neurosurgical rehabilitation is  required to prevent long term  complication.

Multidisciplinary rehabilitation of head injured patient involves speech therapy,behavioral therapy, chest and limb physiotherapy and occupational therapy.

Sensory stimulation program  and use of various graded sensory inputs to facilitate selective motor input.

Bed sore management and proper positioning is use to prevent recurrence of bed sores.

Prevention of contracture and deformities.

Education of caregivers like regular change of position and handling of the patient.

Source: IHBAS, Online Resources