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Discussing Head Trauma

Accidental bumps to the head against a cabinet or playful shoving that leads to head shaking or injury are often overlooked and forgotten. Patients usually only start to notice discomfort three weeks to three months later, seeking consultation from neurosurgeons.

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Clinically, an analysis of over 200 patients with brain injuries revealed that half of them completely forgot any experience of head shaking or trauma. Head shaking or impact is common in daily life, ranging from minor scalp injuries to severe life-threatening unconsciousness. Car accidents or accidental falls causing head impacts should not be disregarded for lack of visible bleeding or injuries; internal bleeding in the brain is a common clinical finding even without external wounds. If head shaking or impact has occurred, patients and their families should be vigilant about certain signs, such as whether there was a brief loss of consciousness or partial amnesia at the time of injury; observe if the injured party remains conscious for more than three days; whether symptoms of headache and vomiting worsen; whether there is numbness or weakness on one side of the body; whether walking is unstable, which could indicate cerebellar injury; and family members should periodically ensure the injured party is awake during the night to prevent sleepiness or unconsciousness due to brain bleeding and increased intracranial pressure.

Classification and Assessment of Head Trauma

The Glasgow Coma Scale (GCS) is a method for assessing a patient's level of consciousness, with a full score of 15 and a minimum of 3. It scores based on the patient's eye-opening, motor response, and verbal response, with the total score indicating the GCS. Within 20 minutes post-head injury, the patient's consciousness level as per the GCS is categorised into:

  1. Mild head injury with a GCS score of 13 to 15.

  2. Moderate head injury with a GCS score of 9 to 12.

  3. Severe head injury with a GCS score of 8 or below.

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Examination and Treatment of Head Trauma

Computerised Tomography (CT Scan) and Magnetic Resonance Imaging (MRI) are widely used, especially CT, which clearly displays various acute intracranial hematomas, brain injuries, and cerebral oedema. Apart from skull X-rays, patients with unclear consciousness, neurological dysfunction, and suspected intracranial hematoma should undergo a prompt CT examination.

Common types of head trauma include:


  1. Scalp hematoma: Post-head impact, most swellings resemble the size of an egg and are painful. This condition does not require medication, rubbing, or heat application and usually resolves in about a month and a half.

  2. Scalp wounds: Attention should be paid to stopping bleeding and keeping the wound clean.

  3. Headache: The variability in post-traumatic headache severity is significant, ranging from mild to unbearable pain, with some experiencing continuous pain and others intermittent bouts. Pain may be dull or pulsatile, burning, or like a pressing sensation, affecting the entire head or specific areas. Changes in posture, stress, fatigue, or exertion can exacerbate the headache, which can be temporarily alleviated by rest or common painkillers.

  4. Dizziness: Post-traumatic dizziness is usually intermittent, lasting a few minutes per episode, triggered by changes in posture or psychological stress, and improves with lying down and closing the eyes. The frequency and severity of dizziness vary greatly. About half of those with mild head injuries experience dizziness, with about half of these lasting for more than two months. Three-quarters of patients with dizziness also experience headaches, and similarly, three-quarters of those with headaches also have dizziness.

  5. Concussion: A mild concussion implies no visible head injury but may result in a brief loss of consciousness, hearing, and smell, or temporary memory loss, headache, dizziness, confusion, blurred vision, unsteady walking, ringing in the ears, nausea, insomnia, inability to concentrate, emotional disturbance, and lack of energy for work. This condition should not be overlooked and requires consultation with a neurosurgeon for proper treatment to avoid permanent sequelae.

  6. Brain injury: Physical damage to the brain near the impact site, often with intracranial bleeding, besides concussion symptoms, severe brain injury can lead to coma, seizures, limb weakness, behavioural or personality changes, rapid breathing, etc.

  7. Intracranial haemorrhage (brain bleeding): Hematoma directly compressing brain nerve tissues can cause headaches, vomiting, rapid breathing, facial or limb twitching, dizziness, limb weakness, numbness, consciousness change, stupor, coma, and without timely medical intervention, permanent disability or life-threatening risks. Among head trauma cases, the most common fatal complication is subdural or epidural haemorrhage. What is Chronic Subdural Hemorrhage? In cases of brain trauma among the elderly or children, particularly those over 50 years old, incidents such as accidentally slipping while getting up to use the toilet at night or stumbling and hitting the head can lead to chronic subdural haemorrhage. This condition often gradually manifests two weeks post-injury and can last up to two years in some cases. Symptoms may include headaches, unilateral weakness similar to a stroke, diminished memory, and cerebellar injuries that may cause bilateral leg weakness, unsteady walking, and decreased appetite. An imbalance of electrolytes can also cause weakness in limbs, leading to delayed medical consultation among many elderly. Generally, the occurrence rate of chronic subdural haemorrhage is low, about 1 to 3%, and the brain can typically absorb the haemorrhage on its own. However, severe bleeding and long-term compression of the brainstem, if not timely relieved through minimally invasive drilling surgery to drain the blood and alleviate pressure, can lead to respiratory suppression, permanent disability, or life-threatening risks. What is Epidural Hemorrhage? Following an impact to the skull, intracranial vessels can be damaged and bleed; the dura mater is the outermost layer protecting the brain. If the bleeding is not severe, unusual severe headaches may appear only in the initial days post-injury (typically four to five days), with some patients being diagnosed with "migraine" or "tension headache" for treatment. Therefore, patients experiencing headache symptoms post-head trauma should inform their physician, allowing for an accurate differential diagnosis.

  8. Cerebral Lacerations and Skull Fractures: Direct damage to tissue, symptoms consistent with brain injury, and intracranial haemorrhage.

  9. Cerebral Edema: Swelling of brain cells post-injury often occurs, leading to central nervous system damage and intracranial bleeding.

  10. Cerebral Ischemia: Often due to increased intracranial pressure leading to insufficient blood supply, causing damage or death to brain cells.

  11. Epilepsy: Approximately 2 to 7% of patients with brain injuries may develop epileptic symptoms, especially those with moderate to severe brain injuries having a higher risk of epilepsy. In such cases, it's necessary to observe the brain waves for abnormalities, and if severe epilepsy is present, antiepileptic medication must be administered for control.

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Epidural hemorrhage refers to the bleeding that occurs within the skull following an impact, where the intracranial vessels are damaged. Given that the dura mater itself is the outermost tough layer protecting the brain, if the bleeding is not severe, unusual and severe headaches may only appear four to five days after the injury.

Precautions for Head Trauma

The first 72 hours post-injury are critical for observation, requiring special attention from patients and their families. If any of the following symptoms arise, immediate contact with a neurosurgeon or direct hospital admission for further examination is advised:

  1. Whether there was a brief loss of consciousness or partial amnesia at the time of injury.

  2. Severe headache or dizziness.

  3. Sleepiness or inability to be woken up (indicating gradually diminishing consciousness).

  4. Apathy towards the external environment, lack of concentration, or changes in personality.

  5. Loss of orientation to time and place.

  6. Nausea, vomiting, or dizziness.

  7. Unilateral numbness or weakness in limbs.

  8. Whether walking is unsteady.

  9. At night, family members of a patient with brain trauma should closely monitor and periodically wake the patient to ensure consciousness, preventing sleepiness or unconsciousness due to brain bleeding and intracranial pressure.

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