Head injury

Head injury symptoms

Minor head injuries may cause headache, bruising, swelling and cuts, which may bleed profusely even if small.

What's usually more worrying than any obvious trauma to the outside of the head (although this can in some instances cause very serious problems) is the possibility of damage to the delicate structures inside the head – to the brain and related tissues. This is referred to as traumatic brain injury or TBI. With any head injury, there's a risk of permanent damage to the brain, especially if the injury is not treated quickly.

The following symptoms may occur soon after the head injury or appear more slowly hours or days later. They are a sign there may be an injury to the brain that needs urgent investigation:

• Headache with nausea and vomiting.
• Blurred or double vision.
• Slurred speech.
• Confusion or drowsiness.
• Loss of consciousness - this is usually a sign that more serious damage to the brain may have occurred.
• Blood or clear fluid (cerebrospinal fluid which normally bathes the brain) from the ears or nose.
• Excessive thirst - this may be an early warning sign that the pituitary gland has been damaged during the injury.
• Loss of sense of smell - this is common in more severe injury and may be prolonged.

These symptoms must always be taken seriously and given proper medical attention.

Longer term symptoms of head injury

Damage or scarring of the brain’s tissues (even sometimes following what appears to have been a minor injury) can lead to chronic disruption of brain function. This may result in a myriad of symptoms such as :

• Headache - scarring of the tissues can disrupt the normal flow of cerebrospinal fluid around the brain, leading to a build-up of fluid (known as hydrocephalus) which may be accompanied by increased pressure within the skull. This is just one of several causes of headache after a traumatic head injury.
• Depression - mood changes ranging from depression to irritability are common after head injury. These can persist indefinitely, and there's a significantly increased risk of suicide.
• Memory problems - loss of memory, including an inability to retain new information or lay down new memories, can be prolonged.
• Movement problems - damage to the motor cortex, which controls movement, can result in paralysis or problems controlling movement.
• Processing difficulties, which interfere with a person’s ability to plan and carry out tasks.

It can also causes a range of symptoms which reflect hormone changes in the body. These may occur when the pituitary gland at the base of the brain is damaged (often by disruption of its blood supply during an injury). The pituitary gland is normally the 'master controller' of many of the body’s hormone systems and may stop producing its own hormones following injury, leading to a condition known as hypopituitarism. Hormone production by other glands of the body falls as a result leading to problems such as:

• Erectile dysfunction in men.
• Loss of libido.
• Loss of periods in women.
• Infertility.
• Weight problems.
• Depression.
• Fatigue.

It's important to note to symptoms may not be immediately apparent but may develop some time after injury.

Head injuries can also cause skull fractures, which may not be apparent unless an x-ray is taken, but which increases the risk of bleeding and significant damage to the brain inside the skull. So it's usually important to x-ray the skull after anything more than a very mild injury and especially when any of the above symptoms are present.

Head injury causes

Road traffic accidents are the single largest cause of head injuries. Other common causes include falls, assaults and sports injuries. Worldwide, traumatic injuries during war, or in some countries damage from falling objects from trees, are also important causes.

Being aware of potential dangers and wearing protective headgear when on bicycles or motorbikes and when playing contact sports can reduce the risk of head injury.

Head injury treatments

Although most head injuries are minor, around one million people each year in the UK need emergency medical care as a result of head injury. Around one in four of these needs to be admitted to hospital. Symptoms can develop some time after a head injury and a history of injury should always be taken into acount in consequent illness.

Treatment of a head injury depends on its type and severity. It may involve:

• Observation at home or in hospital.
• First aid treatment, for example stitching of wounds.
• Medication such as painkillers, corticosteroids and antibiotics.
• Urgent hospital treatment including surgery, for example to decompress the brain, remove blood clots, repair damaged tissues or stop bleeding.
• Management of the consequences and complications of traumatic brain injury - there may be long-term disruption of a person’s ability to look after themselves. Physiotherapy, occupational therapy, speech therapy and emotional and other types of support may be needed, for months and sometimes years. Particular complications may need specific treatment – for example in panhypoituitiarism following TBI, hormone replacement therapy may be necessary for an indefinite period.

If brain damage has occurred, there may be long-term disruption of a person’s ability to look after themselves. Physiotherapy, occupational therapy, speech therapy and emotional and other types of support may be needed, for months and sometimes years.

Advice and support

• Headway - The Brain Injury Association
• Helpline: 0808 800 2244
• Website: www.headway.org.uk

• Brain Injury Rehabilitation Trust
• Telephone: 01924 896 100
• Website: www.birt.co.uk

• Brain & Spine Foundation
• Helpline: 0808 808 1000
• Website: www.brainandspine.org.uk

• Child Brain Injury Trust
• Helpline: 0845 601 4939
• Website: www.cbituk.org