Head Injury – Concussion vs. more serious injury

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This document is for informational purposes only and is not a substitute for being evaluated by a medical provider.

Head injuries are common all year long in the urgent care setting.  In the winter months, skiing or snowboarding is one of the leading causes of head injuries.  In the summer months, more sports injuries occur with the improved weather in the Seattle area.

Most head injuries are not associated with brain injury or longer-term complications.  Rarely, however more significant injuries may develop which could be due to bleeding around the brain.

Causes of head injuries:  Most of the time falls are the cause, but motor vehicle accidents, pedestrian or bicycle accidents and sports-related trauma also cause head injuries.  In the medical setting, we also have to be alert for signs of child abuse as well.  The risk of brain injury depend on the type of trauma and the age of the patient.

Higher risk injuries:

1)   High speed motor vehicle accidents

2)   Fall from a great height

3)   Being hit by a high speed, a heavy or sharp object

4)   Inflicted injury such as abuse

Symptoms of head injuries:

1)   Scalp swelling

2)   Loss of consciousness/passing out – Happens only 5% of the time and usually lasts less than 60 seconds

3)   Headache – Occurs in 20% of patients.  In children who are too young to speak, they may become irritable.

4)   Vomiting – occurs in about 10% of patients.  Children who have a head injury and vomit, do not necessarily have a serious brain injury.

5)   Seizures – Less than 1% of patients have a seizure right after a head injury.  A few of these patients will have a serious head injury.  We will usually do a CT scan of the head if  the patient has a seizure.

6)   Concussion – common symptoms include confusion or inability to remember events around the time of the injury, headache, vomiting, and dizziness.

When to seek help:

1)   The patient has recurrent vomiting

2)   The patient has a seizure (convulsion)

3)   The patient loses consciousness after the injury

4)   Severe headache after the injury, or it worsens with time

5)   Head injury in a child with behavior change (lethargic, difficulty to wake, extremely irritable, other abnormal behaviors).

6)   Difficulty walking, is clumsy or has lack of coordination

7)   Slurred speech or confusion

8)   Dizziness that is not resolving

9)   Blood or watery fluid comes from ears

10)  The patient is a child less than 6 months of age

11)  There is a cut that will not stop bleeding after pressure is applied for 10 minutes

12)  The patient fell from a height greater than 5 feet, or was hit with a high speed object or with great force

13)  Patient’s friends/family are concerned about how the patient is acting

When do I need a Cat Scan/CT Scan of the brain?  A CT scan is a special X-ray that expose children/adults to radiation and should be avoided if possible.  Sometimes, however a Cat scan will be recommended to diagnose more severe injuries.  Some possible symptoms which may prompt your medical provider to order a CT scan are:

1)   Prolonged loss of consciousness

2)   Persistent or severe memory loss/confusion

3)   Persistent vomiting

4)   Seizure

5)   Severe, persistent or worsening headache

6)   Suspicion of intentional injury (abuse)

7)   Behavioral changes (lethargy, decreased alertness, extreme irritability)

8)   Signs of skull fracture such as a bulging fontanel or skull deformity

9)   Abnormal neurological exam

10)  Severe scalp bruising or swelling in a very young child

Why not an MRI?  We use CT scanning instead of an MRI to look for brain injury in most head injuries because it is available at most hospitals, and CT is relatively quick compared to MRI.  MRI requires patients – including children to be completely still for at least 30 minutes and that can be challenging.

Head injury treatment at home:

1)   Rest – lie down or participate in quiet activities

2)   If the head is bleeding, clean the area with soap and water and apply pressure with gauze.  If bleeding does not stop, the child should be evaluated

3)   Tylenol may be given in most cases for pain/headache.  If the headache worsens, please have the child evaluated (see above).

Monitoring after head injury:  The patient should be observed for signs of worsening injury.  Please call your healthcare provider if any of the following are noted:

1)   Vomiting more than once or vomiting continues for 4-6 hrs after the injury.

2)   Severe/worsening headache

3)   Becomes more drowsy or hard to wake up.

4)   Confused or not acting normally.

5)   Has trouble walking, talking or seeing

6)   Develops stiff neck.

7)   Has a seizure (convulsion) or any abnormal movements or behaviors.

8)   Cannot stop crying – children

9)   Has weakness or numbness involving one side of the body.

Return to normal activities:  Patients who have sustained a concussion are at a risk for serious or even fatal complications of they have a second injury within a short time after the first injury – this is called second impact syndrome.  It important not to participate in high impact sports or risky activities for 6 weeks.

Post-concussion syndrome:  Sometimes the patient who has sustained a head injury may develop a group of symptoms in the first few days after the injury called “post concussion syndrome.”  These symptoms can include headaches, anxiety, irritability, dizziness, or impaired memory or concentration.  In 85-90% of patients, this resolves within a few weeks-few months after the injury.  There isn’t any specific treatment for post-concussion syndrome.

Head injury prevention:

1)   Wear a bicycle helmet when riding bikes, skating , sledding or participating in activities where you may hit your head

2)   Install car seats/booster seats correctly.  At least a booster seat is needed until the child is at least 4 feet 9” tall.  Individual states may have additional regulations about the use of booster/car seats.

3)   Use gates on stairways to prevent injuries in infants/young children

4)   Install window guards on all windows above the first floor

5)   Do not use wheeled baby walkers

6)   Teach kids to safely cross the street.  Young children should never cross the street alone.

7)   Discuss sports safety with your healthcare provider.  Be sure that a child has appropriate protective equipment.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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