Head Injury : Skull Fracture and Concussion

Head injury remains a significant cause of death in patients who are victims of multiple trauma (e.g. motor vehicle accidents). Several distinct types of head injury can be identified.

HEAD CONTUSION - This refers to a soft tissue injury (bruise) that does not involve the skull or brain. Bleeding from scalp lacerations can be controlled with a pressure dressing or direct pressure [with a clean cloth or gauze].

CONCUSSION - This refers to a specific clinical diagnosis where loss of consciousness, amnesia, seizure, or some combination of these conditions are present in the patient's history. This is often referred to as a brain contusion.

SKULL FRACTURE - This refers to an actual break in the bones of the skull. Patients with a skull fracture will most often have an area of localized swelling and tenderness. Children under the age of 2 years can sustain a skull fracture (from a head injury) and have little or no evidence on physical examination of the head. In this special case, skull x-rays are performed so skull fracture will not be overlooked.

EPIDURAL HEMATOMA and SUBDURAL HEMATOMA - These refer to specific areas of intracranial (inside the skull) bleeding. A heavy, layered sheath covers the outside of the brain, known as the dura mater. Bleeding may occur and accumulate under the dura (subdural hematoma), or outside of the dura (epidural hematoma). Both conditions require IMMEDIATE Neurosurgical intervention. Another form of intracranial bleeding, secondary to head injury, is known as subarachnoid hemorrhage.

It is very important to recognize the factors which determine the severity of a head injury.


1. LOSS OF CONSCIOUSNESS - This last anywhere from 2 to 10 minutes, on average.

2. AMNESIA - This refers to an inability to remember events prior to or just after the head injury ("How did I get to the hospital?").

3. SEIZURES - Convulsions after a head injuries are common.

4. CONFUSION - The patient is not his or her "normal" self. These patients tend to keep asking the same questions over and over, despite your answering them several times.

5. NEUROLOGIC IMPAIRMENT - This may occur may as a paralysis to one side of the body, difficulty with balance (walking), coma, or unequally dilated pupils. This is an indicator of severe injury and increases the likelihood of EPIDURAL, or SUBDURAL HEMATOMA.

The above represent symptoms of SERIOUS head injury. There are also several other COMMON SYMPTOMS that are seen in most head injuries: nausea with vomiting, giddiness, and sleepiness.

Evaluation will include a careful history for any of the serious symptoms of head injury. Physical examination may reveal tenderness to palpation, swelling, deformity, or crepitation to the scalp. The finding of blood or clear fluid coming from an ear canal or nose, can also indicate skull fracture. Bilateral "black eyes", or a discolored bruise behind the ear can also indicate fracture. Examination for associated neck injury is also important. Patients with suspected skull fractures will require skull x-rays. CT-scanning of the brain will be reserved for patients exhibiting any of the SERIOUS features of head injury, or in those with fractures demonstrated by skull x-rays. CT-scanning allows the doctor to "see" the brain itself and judge the extent of brain damage. Many times, the decision to operate is made on the findings of these important studies.

In conclusion, the majority of patients WITHOUT ANY of the serious features of head injury, or important clinical exam findings, do well with close observation.


* Checkups each hour for "normal" behavior.

* Checkups each hour to make sure the patient can be easily awakened.

* Observation of the patient's ability to walk or maintain balance.

* Observation for nausea and vomiting (dehydration).

* Observation of patient's ability to converse normally and move all 4 extremities.

In most cases acetaminophen or an anti-inflammatory (ibuprofen) will be adequate for pain. Avoidance of alcohol, sedatives, sleeping pills, or narcotic pain medicines is strongly advised. The effects of these agents can mask the symptoms of a serious head injury.


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Abdominal Injury
Abdominal Injury: Contusion
Animal Bites
Ankle Fracture
Ankle Injury
Ankle Injury: Contusion
Ankle Sprain
Back Injury
Back Injury : Sacrococcygeal Injury
Back Strain
Carbon Monoxide Poisoning
Chemical Burns
Chest Injuries
Chest Injury: Aortic Rupture
Chest Injury: Hemothorax
Chest Injury: Myocardial Contusion
Chest Injury : Pneumothorax
Chest Injury: Pulmonary Contusion
Chronic Back Pain
Clavicle Fracture
Compression Fractures
Decompression Sickness
Disc Disease
Gunshot Wounds
Hand Injury: Fingertip Amputations
Head Injury
Liver Injury
Marine Stings
Muscle Strains
Rib Fracture
Ruptured Spleen
Shoulder Injury: A-C Separation
Spider Bites
Spinal Cord Injury
Sternum Fracture
Testicular Injury
Wrist Injury
hi Scuba Related Injuries
i Hand Injury Finger Amputaion
de Lecerations
de Cold Injury and Hypothermia
dd Dental Injury
xs Facial Injury
sdf Neck Injury
e Shoulder Injury Dislocation
e Ear Injury
ed Elbow Injury
de Elbow Injury Fracture
dfe Elbow Injury Nursemaids
ee Electrical Injury
de Eye Injury
ed Facial Injury General Considerations
fr Facial Injury Contusion
ed Hand Injury Finger Sprains
ded Fingernail and Toenail Injuries
dd Hand Injury Fractures
23 Head Injury Skull Fracture and Concussion
44 Chest Injury Myocardial Contusion
fde Heat Illness
ed Hest Injury Hemothorax
y Back Injury Disc Disease
;l High Altitude Illness

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