Head trauma can occur in very different settings. Prior to the introduction of seat belts it was common with automobile accidents.
Sports injuries, particularly contact sports, is often associated with a higher risk of head trauma. An infant may have been born with a difficult forceps delivery and there is a higher risk for head trauma as well. Boxing and assaults are also a frequent source of head trauma. It is important for the physician in the Emergency Room setting of a hospital to assess whether or not there is a skull fracture present, whether or not an intracranial bleed has occurred and whether or not there are other injuries associated with it like cervical spine fractures or vascular injuries around the neck and chest region.
Signs and symptoms
The level of consciousness is assessed with the Glasgow coma scale, where a standard assessment is made with regard to level of responsiveness, muscle power, and eye muscle control.
The scale ranges between 3 and 15. A severe head trauma would be defined by a Glasgow scale of 8 or less 48 hours after the trauma (Ref. 6, p. 425). Often there may bleeding from the areas such as the ear canal or the nose. The physician would have a high index of suspicion for a basal skull fracture in these cases.
As mentioned under “epidural hematoma” there can be a lucid interval and then unconsciousness sets in. There might be a sudden bout of seizure and the diagnosis would be post-traumatic epilepsy. The symptoms are determined by the specific area of the head or the brainstem that is injured and the associated other injuries such as cervical spine fractures.
The emergency physician and specialists such as neurologist and neurosurgeon will likely order emergency CT and/or MRI scans.
Other X-rays such as cervical spine x-rays are often needed. The other tests needed depend on the clinical presentation.
A person with a severe head injury may need intubation and artificial respiration for a period of time until the level of consciousness and spontaneous breathing are normalizing. Hyperventilation can help to reduce the intracranial pressure via blood vessel constriction. Osmotically active intravenous substances such as mannitol can be utilized to reduce the intracranial pressure for 6 to 8 hours with every dose (Ref. 6, p. 428). Surgical decompression by placing burr holes neurosurgically may be required. Seizure prophylaxis and antibiotic prophylaxis may be necessary depending on the underlying injury (Ref. 6, p. 429).
1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company
2. B. Sears: “The top 100 zone foods”. Regan Books, Harper Collins, 2001.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 176.
4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby, Inc.
5. Goroll: Primary Care Medicine, 4th ed.,2000, Lippincott Williams & Wilkins
6.Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998, Mosby-Year Book, Inc.
7. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001, W. B. Saunders Company
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
10. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008