Serious Head Injuries May Seem Mild At First

Posted on Tue., August 19, 2008
By Neil Jayasekera, MD

Recently, a young man came to the ER complaining of headaches, progressive weakness in his left arm and leg, difficulty walking, and increasing fatigue.

He had fallen and hit his head the week before, but at the time he had been preoccupied with studying for an important exam and thought his symptoms were from the stress of studying.

We discovered a large clot in his brain, a result of his fall. But soon after his admission to the hospital, he slipped into a coma, and ended up requiring surgery to remove the blood clot and medicine to reduce the swelling of his brain.

Most deaths for people younger than 45 are caused by injuries (called "trauma" by doctors), and the majority of these deaths are from head injuries. Our patient was lucky his injury was caught in time.

Head injuries, known to doctors as Traumatic Brain Injuries (TBIs), are divided into two categories, penetrating and blunt.

Penetrating injuries occur when an object breaks through the skull into the brain, such as a gunshot wound to the head. Blunt injuries occur when the head hits an object, such as in a football game, fall or car accident, but nothing breaks through the skull into the brain.

Both these types of head injuries can cause permanent brain or nerve damage and death. Blunt trauma can be harder to diagnose because you often can´t see the severity of the injury as there may be no bleeding, bruising or swelling on the outside of the head.

Blunt head trauma can cause arteries or veins inside the skull to tear and leak. If the leak is small and slow, the symptoms may not occur for days or weeks.

Many TBIs are preventable. Wearing seat belts, being sure your car's airbags are working, and using child car seats properly all reduce the risk of a head injury. Wearing a helmet when biking, skateboarding or both, or other contact sports can protect your head.

If you have problems with balance or movement, installing handrails and assist devices can prevent falls that cause head injuries. Also, driving under the influence of alcohol or drugs increases your chances of a car accident, a major cause of TBIs.

People older than 60 are at particularly high risk of a severe TBI caused by a mild head injury. This may be because the blood vessels in their brains are more fragile.

Children younger than 2 are also vulnerable because they cannot express themselves, making it difficult to know if their head injury is causing damage.

Children and seniors are more likely to be injured because their reflexes are slower; therefore they have more difficulty protecting themselves if they fall and hit their head.

Certain medical illnesses and blood-thinning medications increase a person´s risk of bleeding, which increases the likelihood of brain damage if you do suffer a TBI. Other pre-existing medical conditions or medications can affect your balance, which can lead to a fall and increase your risk for a head injury.

Call 911 if you or someone you know sustains head trauma and experiences loss of consciousness, severe or worsening headache, confusion, weakness that involves one side of the body, recurrent vomiting, severe dizziness, memory loss and/or difficulty walking or keeping balance.