Head injury is the alteration in conscious level of the patient as a result of non-penetrating injury to the brain. Head injury is the leading cause of death between the ages of 1 and 45 and is the fourth most common cause of death in United States. Head injury is responsible for 200 to 300 hospital admissions per 100,000 population. Because of young age at which most of the head trauma occurs, long-term physical and neurological incapacitation is high and is associated with social and occupational dysfunction. Associated spinal injury is also common in patients with head injury. Proper management of head injured patients is essential for better patient recovery.
How do you classify head injuries?
Head injuries are classified into mild, moderate and severe based on a scale called Glasgow coma scale. The minimum score is 3 and the maximum score is 15. Normal persons have a score of 15. Patients with score 14 and 15(with some brief loss of conscious level) are classified as mild head injury patients. Patients with score less than 8 are severely injured.
What is the risk of brain damage in the patients with head injury?
Many studies have been conducted and the following patients with head injury are likely to have low risk for brain damage. They belong to the mild head injury group. In a series of 10,000 cases of mild head injuries, as per the following criteria only 8 patients had serious injury to the brain.
Who are the patients having a risk of brain injury in case of head injury?
- Patients who have no symptoms or complaints.
- Patients who have only mild headache.
- Only Scalp injury (injury to the skin over the head with some abrasion or contusion) is present.
- No loss of consciousness
- No history of vomiting
- No memory disturbances
- No history of alcohol intake at the time of accident.
When is CT scan indicated for a patient with head injury?
- Patients with low level of consciousness or in state of coma
- Patients with alcohol intoxication
- Patients with skull fracture
- Patients who have weakness or numbness of limbs.
CT scan of the head is used to find out any blood clot or bleeding in the brain or if there is any fracture of the skull bone. Nowadays with the latest CT scan machines, scan can be completed in less than a minute. CT scan must be taken in a case of head injury, if the patient has any of the following problems.
What is the treatment for the patient with head injury?
- History of loss of consciousness for more than 10 minutes.
- Alcohol intoxication.
- History of seizures (fits).
- Unreliable history of the accident.
- Age less than 2 years.
- History of persistent vomiting.
- Bleeding from the nose, mouth or ear.
- Patient has serious facial injury.
- Penetrating injury to the skull.
The patients with mild head injury can be discharged and observed at home. The patient with mild head injury should immediately seek medical help if he notices any of the following conditions.
- Change in level of consciousness (including difficulty in awakening).
- Abnormal behavior.
- Increased headache.
- Alteration in speech.
- Weakness of limbs.
- Numbness over the limbs.
- Persistent vomiting.
- Enlargement of one or both the pupils (the black round part in the middle of the eye) that does not get smaller when a bright light is shined on it.
- Seizures (convulsions or fits).
- Significant increase in swelling at the site of injury.
The patient must not take sedative drugs. Acetaminophen (Tylenol) can be taken for pain. In the case of patients with severe head injury, having a blood clot inside the brain (for e.g., extradural haematoma), surgery will be required to remove the clot.