Click here to view next page of this article

Head Injury

Trauma is the most common cause of death in young people, and head injury accounts for almost half of these trauma-related deaths. The prognosis following head injury depends upon the site and severity of brain damage.

Note: Patients who have lost consciousness for 2 minutes or more following head injury should be admitted to the hospital for observation.

Cerebral Injuries

These are summarized in Table 24B5 along with comments about treatment. Increased intracranial pressure may result from ventilatory obstruction, abnormal neck position, seizures, dilutional hyponatremia, or cerebral edema; an intracranial hematoma requiring surgical evacuation may also be considered.

Sequelae Clinical Features Pathology

Concussion Transient loss of consciousness with Bruising on side of impact (coup).

bradycardia, hypotension, and injury) or contralaterally (contrecoup).

respiratory arrest for a few seconds injury).

Followed by retrograde and posttraumatic amnesia. Occasionally followed by transient neurologic deficit.

Cerebral contusion may lead to death or hemorrhage, and necrosis.

severe residual neurologic deficit. have subarachnoid bleeding.

Scalp Injuries and Skull Fractures

Scalp lacerations and depressed or compound depressed skull fractures should be treated surgically as appropriate. Simple skull fractures require no specific treatment.

The clinical signs of basilar skull fracture include bruising about the orbit (raccoon sign), blood in the external auditory meatus (Battle's sign), and leakage of cerebrospinal fluid (which can be identified by its glucose content) from the ear or nose. Cranial nerve palsies (involving especially the first, second, third, fourth, fifth, seventh, and eighth nerves in any combination) may also occur.

Late Complications of Head Injury

The relationship of chronic subdural hemorrhage to head injury is not always clear. In many elderly persons there is no history of trauma, but in other cases a head injury, often trivial, precedes the onset of symptoms by several weeks. The clinical presentation is usually with mental changes such as slowness, drowsiness, headache, confusion, memory disturbances, personality change, or even dementia.