Head Injury and Traumatic Brain Injury

What is this condition?

Head injury ranges from scalp wounds and concussion to skull fracture, brain bruising, diffuse axonal injury and intracranial bleeding. A normal-looking patient can deteriorate later, especially when taking blood-thinning medicine, intoxicated, elderly or unable to describe symptoms. The aim of assessment is to identify who can be observed safely and who needs urgent imaging or intervention.

What symptoms can it cause?

• Loss of consciousness, memory gap, confusion or unusual behaviour
• Repeated vomiting, worsening headache, seizure or increasing sleepiness
• Weakness, unequal pupils, fluid/blood from nose or ear
• In children: persistent irritability, poor feeding or abnormal drowsiness

How is it assessed and diagnosed?

Assessment uses the history of mechanism, loss of consciousness, medicines, alcohol/drugs and neurological examination including Glasgow Coma Scale. CT is selected using clinical risk factors and is urgent in severe or worsening injury. MRI can help later when symptoms persist or diffuse injury is suspected but is not the usual first emergency test.

Treatment without surgery

Mild concussion is treated with relative physical and cognitive rest followed by gradual return to activity. Complete prolonged bed rest can delay recovery. Pain and nausea medicines are selected safely; alcohol, driving, contact sport and unsupervised sedatives are avoided. A responsible adult should observe the patient according to discharge instructions.

When is surgery or a procedure considered?

Surgery is needed for selected epidural, subdural or intracerebral haematomas, depressed skull fractures, penetrating injuries, CSF leaks or uncontrollable pressure. Options include burr-hole drainage, craniotomy, decompressive craniectomy and intracranial-pressure monitoring. The decision is based on scan, consciousness, pupils, neurological change and overall injuries.

Treatment and procedure options

• Observation and concussion rehabilitation
• Repeat CT and neurocritical monitoring
• Burr-hole or craniotomy evacuation of a haematoma
• Decompressive craniectomy for refractory swelling
• Repair of skull fracture, penetrating injury or CSF leak when required

Risks from the disease and from treatment

Complications include delayed bleeding, swelling, seizures, infection, CSF leak, clots, pneumonia and cognitive, behavioural or emotional change. Surgery treats a mass or pressure but cannot reverse all microscopic brain injury. Repeat head injury before recovery can be dangerous. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Recovery may involve headache, dizziness, poor sleep, fatigue, irritability and slowed concentration. Return to school, work, driving and sport should be staged. Severe injury may need prolonged multidisciplinary rehabilitation and caregiver support. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• CDC — Traumatic Brain Injury: https://www.cdc.gov/traumatic-brain-injury/index.html