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Closed Head Injury

Definition

A closed head injury is trauma to the head that does not cause a break in the skull. Though the skull is intact, the brain and soft tissue can be damaged by violent movement of the brain in the skull. This can lead to bleeding and swelling inside the skull.

This type of injury is often minor but can lead to a traumatic brain injury which can cause a range of symptoms. Brain injury may be caused by the initial trauma or secondary injury. Secondary injury is caused by bleeding and swelling that is severe enough to increase the pressure on the brain. This pressure can lead to secondary damage and symptoms which may take hours to days to develop.

Causes

Closed head injuries are caused by a blow to the head or severe jerking motions of the head, neck or body. The most common traumas associated with head injuries include:

  • Accidents (such as automobile, work-related, sports-related)
  • Falls
  • Abuse, such as shaken baby syndrome
Head Injury
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Risk Factors

Factors that may increase your chance of a closed head injury include:

  • Advanced age—increased risk of falls
  • Younger age— increased risk of motor vehicle accidents
  • High-impact sports, such as boxing, basketball, baseball, or football
  • Physical abuse
  • Alcohol or drug abuse

Symptoms

Symptoms can appear right away, or in the days and weeks following the injury. Symptoms may include:

  • Headache
  • Loss of consciousness or sleepiness
  • Dizziness
  • Having trouble with memory or paying attention
  • Double or blurry vision
  • Nausea
  • Problems speaking, communicating, or putting thoughts together

A doctor should be consulted right away if any of the following is present:

  • Seizures
  • Vomiting
  • Pupils that are larger than normal or different size pupils
  • Unexpected mood swings or behavioral changes
  • Drainage of blood or clear fluids from nose or ears
  • Weakness or numbness in arms or legs

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 how the injury occurred. A doctor that specializes in the nervous system may be consulted.

Neurological tests will be completed. The tests will include observation of eye movements, limb movements, the ability to follow commands, and coherence of speech. The tests will help assess the impact on the brain tissue. The tests will also mark current level of symptoms to help measure any improvement or worsening.

A CT scan may be done if there are severe symptoms or certain risk factors but are not always needed.

Treatment

Treatment will depend on the location and severity of the injury and specific symptoms. Both mental and physical rest will be needed to help any brain injury heal.

Minor (Mild) Injury

Minor injuries can temporarily affect how the brain works. It can affect brain tasks like memory, balance, concentration, judgement, and coordination. With simple rest, nearly all will have a full recovery.

Both mental and physical rest will be needed to allow the brain to heal. This includes limiting mental tasks like work or school. Returning to normal activities too soon can make symptoms worse and slow recovery. A gradual return to activities will also help minimize symptoms and continue recovery.

Return to a sport or recreational activity that was involved with the head injury may take longer. A second head injury before the brain has fully recovered can lead to more serious brain injury and damage.

Moderate or Severe Injury

Moderate or severe injuries can cause a lot of bleeding and swelling in the brain. The brain sits in an enclosed pocket made of protective tissue, a fluid called the CSF, and the skull. The bleeding or swelling of the brain or supporting tissue can suddenly increase the pressure in this pocket. The pressure can damage the brain and make current function difficult. With a closed head injury the skull remains intact which prevent a relief ffrom the pressure build up.

Immediate emergency care is required for moderate or severe head injuries to:

  • Manage current injury
  • Decrease risk of further injury
  • Provide support like oxygen if needed

Medication may be used to help reduce swelling on the brain. The injury to the brain may stimulate seizures. Medication may help to manage or stop these seizures.

Surgery may be needed to help relieve this pressure. Options include:

  • Making burr holes through the scalp and skull to allow excess fluid to drain out.
  • Craniotomy—removing a section of the skull to allow room for swollen tissue. May be needed if the brain is swelling.

Recovery

Regular testing and monitoring will assess how the brain is recovering. It can take months or years for a complete recovery though symptoms should gradually improve during this time. The length of recovery will depend on a number of factors such as severity of injury, overall health, and age. Neurological and psychological testing will help monitor progress and guide rehabilitation.

Rehabilitation services such as physical therapy or occupational therapy may be needed during recovery for people with severe injuries. Therapy may help relearn movement, speech or memory processes, or adjust to challenges during recovery. Counseling may also be needed to manage frustration and anxiety during extended recoveries.

Prevention

A closed head injury is often the result of an accident which can be difficult to prevent. To decrease the chance of severe injuries during an accident:

  • Always use seatbelts, shoulder harnesses, and child safety seats when traveling in vehicles. Follow recommendation for child car safety options.
  • Learn about the air bags in your car. Young children should not be placed in front of airbags. Check your cars specifications.
  • Wear a helmet when participating in high risk activities such as:
    • 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

Falls are a common cause of head trauma, especially in older adults. To reduce the risk of falls:

  • Use handrails when walking up and down stairs
  • Have safety gates by stairs and safety guards by windows
  • Use grab bars in the bathroom
  • Place non-slip mats in the bathroom
  • Keep walkways clear to avoid tripping
  • Make sure rooms and hallways are well-lit

Revision Information

  • American Academy of Neurology

    http://www.aan.com

  • Brain Injury Association of America

    http://www.biausa.org

  • The Brain Injury Association of Canada

    http://biac-aclc.ca

  • Ontario Brain Injury Association

    http://www.obia.on.ca

  • Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2009. Accessed May 19, 2009.

  • Mild traumatic brain injury/Concussions. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/concussion/feel%5Fbetter.html. Updated February 26, 2015. Accessed May 4, 2015.

  • The management of minor closed head injury in children. Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research, American Academy of Family Physicians. Pediatrics. 1999;104:1407-1415.

  • 10/5/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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;95(1):1-9.