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Closed Head Injury

(Traumatic Brain Injury)

Definition

A closed head injury is trauma to the head that causes the skull and brain to knock or shake. Internal damage can occur to the:
  • Skull
  • Brain
  • Blood vessels
  • Layers between the skull and scalp
This damage can cause swelling or pressure on the brain. The injury can be throughout the brain and skull; or it can be in one region.
Often times, the head injury is minor. However, it can serious and life threatening. It requires care from a doctor.

Causes

Closed head injuries are caused by trauma to the head. This is often due to:
  • Accidents (such as automobile, work-related, sports-related)
  • Falls
  • Abuse
Head Injury
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Risk Factors

These factors increase your chance of developing a closed head injury:
  • Being of advanced age (due to greater risk of falls)
  • Being of relatively young age (higher risk of motor vehicle accidents)
  • Playing high-impact sports (especially boxing, basketball, baseball, football)
  • Being physically abused (such as shaken baby syndrome)
  • Having a previous head injury or concussion
  • Abusing alcohol or drugs
Tell your doctor if you have any of these risk factors.

Symptoms

Symptoms can appear right away or the days and weeks following the injury.
If you have any of these symptoms. do not assume it is due to closed head injury. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
  • Symptoms of a concussion:
    • Confusion, loss of memory about the accident
    • Low-grade headache or neck pain
    • Nausea
    • Having trouble remembering, paying attention, organizing, making decisions
    • Slowness in thinking, acting, speaking, or reading
    • Feeling fatigued or tired
    • Change in sleeping pattern (such as sleeping longer, having trouble sleeping)
    • Loss of balance, feeling light-headed or dizzy
    • Increased sensitivity to sounds, light, distractions
    • Blurred vision or eyes that tire easily
    • Loss of sense of taste or smell
    • Ringing in the ears
    • Feeling sad, anxious, or listless, lacking motivation
    • Becoming easily irritated or angry for little or no reason
  • Symptoms of a skull fracture or focal brain injury:
    • Leaking cerebrospinal fluid
    • Blood in the ears
    • Weakness or numbness of the limbs
    • Pain
    • Swelling, tenderness at injury site
    • Headache
    • Hearing loss
    • Progressive worsening of cognition or level of alertness
Be sure you know which symptoms your doctor needs to know about right away. If you have been evaluated for a closed head injury and your symptoms are getting worse, get medical help right away.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a neurologist for special testing.
Tests may include:
  • CT scan—to make pictures of structures inside the head
  • CT angiography—to identify arterial bleeding
  • MRI scan—to make pictures of structures inside the head
  • Blood tests
  • Neurological examination
  • Neuropsychological tests
  • EEG (electroencephalogram)—a noninvasive test used to evaluate brain function
Imaging studies are not routinely done in children with minor head injuries. Your child may be observed to determine if imaging studies are needed.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment will depend on:
  • Your symptoms
  • Location and severity of the injury
Treatment options include the following:

Monitoring and Observation

For minor injury with little or no symptoms, your doctor may advise that you watch for symptoms to develop in the days and weeks that follow.
If you have a concussion, a responsible adult will need to observe you. You may also need to limit drug and alcohol use.

Neuropsychological Testing

You may need more testing done. These tests assess how your brain functions. The results can help your doctor determine:
  • How you are recovering
  • Whether you are ready to return to high-impact activities

Counseling

You may be referred to a counselor to take part in a rehabilitation program to improve functioning.

Medications

Your doctor may prescribe medicine to:
  • Reduce pressure inside the head or brain swelling
  • Prevent seizures (given in some cases)
  • Reduce pain

Surgery

This usually involves making “burr holes” in the scalp and skull and draining the clotting blood. Sometimes a section of the skull is removed to relieve pressure. This is called a craniotomy.

Prevention

To help reduce your chances of getting a closed head injury, take the following steps:
  • Do not drink alcohol and drive.
  • Do not take medicines that may make you sleepy, especially when driving or using heavy equipment.
  • Obey speed limits and other driving laws.
  • In vehicles, always use seatbelts, shoulder harnesses, and child safety seats. Only use child safety seats when traveling. Do not use them outside of the vehicle.
  • Learn about the air bags in your car.
  • Wear a helmet when:
    • Riding a bike or motorcycle
    • Playing a contact sport like football, soccer, or hockey
    • Using skates, scooters, and skateboards
    • Catching, batting, or running bases in baseball or softball
    • Riding a horse
    • Skiing or snowboarding
  • Wear mouth guards, face guards, pads, and other safety gear while playing sports.
  • Make sure your child's play surface is soft and free of rocks, holes, and debris.
  • Reduce falling hazards at home for children and adults, by:
    • Using handrails when walking up and down stairs
    • Having safety gates by stairs and safety guards by windows
    • Using grab bars in the bathroom
    • Placing non-slip mats in the bathroom
    • Keeping walkways clear to avoid tripping
    • Making sure rooms and hallways are well-lit
  • Keep firearms and bullets locked safely away.

RESOURCES

American Academy of Neurology http://www.aan.com

Brain Injury Association of America http://www.biausa.org

CANADIAN RESOURCES

The Brain Injury Association of Canada http://biac-aclc.ca

Ontario Brain Injury Association http://www.obia.on.ca

References

American Academy of Pediatrics. The management of minor closed head injuries in children. Pediatrics. 1999;104:1407-1415.

Closed head injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2009. Accessed May 19, 2009.

10/5/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007. Pediatrics. 2010;126(2):352-357.

4/1/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.

5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cantor J, Ashman T, et al. Evaluation of short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil. 2014 Jan;95(1):1-9.e3.

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