HEAD INJURIES
It is no exaggeration to say that there is not a single person on Earth who has never had or will never have a head injury. The injury mechanics however play an important role in the severity of the injury. Falling from a high altitude and car/motorcycle accidents during high speed are usually related to major craniocerebral injuries while falling from our body height, car/motorcycle accidents during slow speed, beatings, and the head hit by a heavy item are usually related to minor head injuries.
Minor head injury
Following a minor head injury, the patient has their senses, remembers everything before and after the injury, doesn’t vomit, and doesn’t show any neurological symptoms. On the other hand, the patient may have a headache, may feel dizziness or have external injuries, such as a wound underneath the hair or a bruise with or without swelling.
Symptomatic treatment is required for a minor head injury, specifically, pain treatment and/or wound treatment with sutures and antibiotic treatment, and monitoring of the consciousness level by a responsible adult for at least 24 hours. In children younger than 2 years old, this monitoring is done in a pediatric surgery hospital. Minor head injuries consist of most of the head injuries while medium and major head injuries are rarer but a lot more important for patients’ lives and neurological integrity.
Medium and major head injuries
The typical symptom of major head injuries is the level of consciousness (decreased communication capability), which is not always as serious and it is accompanied by a variety of symptoms, such as intense headache, vomiting, and neurological symptoms (muscle weakness on one limb, numbness, dysarthria, aphasia, etc.). In these cases, a brain CT scan is mandatory (not an MRI scan) to identify post-traumatic findings that can be related to brain and facial skeleton (skullcap fractures, skull base fractures, facial skeleton fractures), brain parenchyma (brain injury, post-traumatic intracerebral hematomas, brain swelling, etc.), or the surrounding spaces of the brain (epidural hematoma, acute subdural hematoma, post-traumatic subarachnoid hemorrhage).
The neurosurgeon will define the injury treatment (conservative or surgical) depending on its severity. Treatment starts at the accident spot if possible (by the emergency medical services), continues in the emergency room (application of ATLS principles by the trauma team), on many occasions it goes through the surgery room (hematoma drainage with craniotomy or craniectomy, application of intracranial catheter that will measure and document the intracranial pressure [ICP], etc.), and it ends up in the intensive care unit (ICU).
Patients with head injuries may require a long-term recovery that will usually involve the collaboration of physiatrists, physical therapists, speech therapists, and more medical and paramedical specialties in special recovery centers.
Prognosis for major head injury is extraordinary for a third of the patients (they go back to work), medium for the next third of the patients (survival with a disability that prevents patients from going back to work), and very bad (death or vegetative state) for the last third of the patients.
