Do you know how to recognise a serious head injury?

Posted on 5 March 2019

Head injuries can vary in degree from minor knocks to serious trauma. A neurologist at Mediclinic Sandton explains how important it is to distinguish between the two.

There are generally two types of head injuries – those that are impact-related (for example, caused by falls, vehicle accidents, contact sports-related accidents, or physical violence) and those caused by being vigorously shaken.

A serious head injury is one that results in significant mechanical head trauma, be it a fracture to the skull, bleeding on the brain or any damage to brain tissue.

Symptoms of a serious head injury

“If someone has a fall and bumps their head, one should assess them within five minutes and again after half an hour,” says Dr Alexander Landmann, a neurologist at Mediclinic Sandton. “After 30 minutes, if they’re still confused, can’t follow commands, or their eyes won’t open spontaneously, they could well have a serious head injury. Also, if there is a complete loss of consciousness for longer than a minute, you should call an ambulance or take them to an emergency department to have them checked out.”

Common symptoms include:

• headache
• dizziness or light-headedness
• mild confusion
• nausea or vomiting
• disorientation
• an inability to focus or to keep the eyes open

Contact incidents in sports such as rugby, boxing and wrestling are common causes of concussion. The effect of sudden hard impact to the head during a tackle or in a scrum can violently jolt the brain, causing bruising, damage to the blood vessels and injury to the nerves.

Dr Landmann explains that repeated exposure to head knocks can cause damage to nerve fibres inside the brain. If continued over time, this can result in a progressive neurological disorder affecting cognitive functions and movement.

“This is common in professional athletes involved in contact sports for an entire career and presents a very real risk,” he says. “It’s also seen in very enthusiastic school kids playing vigorous contact sports.”

Risks of not recognising a serious head injury soon enough

Brain tissue damage that goes unrecognised will leave a lasting neurological deficit of some sort. Even if the patient is able to regain consciousness, there will be some kind of a deficit in their functions.

“More importantly, if the trauma results in a bleed on the brain, it’s a medical emergency that needs to be surgically corrected,” Dr Landmann adds. “If not recognised, the condition can be life-threatening. Initially, the patient’s condition might not look too bad, but will deteriorate – an expanding blood clot around the brain will compress the brain progressively, leading to drowsiness, coma and even death.”

Do symptoms and prognosis differ between young children and adults?

Children tend to have fewer post-concussion symptoms than adults. Dizziness, balance problems and difficulty with concentration are more common in adults after traumatic brain injury or mild concussion, but both children and adults can develop bleeds around the brain when sufficient force is applied to the head. If not recognised early, the condition can very rapidly deteriorate.

People on blood-thinning medication and the elderly are particularly at risk of developing these sorts of bleeds.

“If young children sustain any sort of head injury where there is a loss of consciousness, parents should not hesitate to take them to an emergency facility for a brain scan. This is a quick and easy test, and will show conclusively if there’s something to worry about or not,” says Dr Landmann.