Head injury

Head trauma / head injury

Presentation

Trauma presentations are usually obvious to ellicit

Types of head trauma

• Fall

  • • • Trip/ walking

      • Sport related: horse riding, mountain/ road biking, 

      • Snow: skiing, sledging, iceskating

      • DIY- fall of ladder etc

• Transport

  • • • RTC: road traffic collisions

      • Note RTA is out of date as accidents implies they are not preventable

      • Car, bicycle, motorbike, bus and pedestrian

• Non accidental

  • • • Assault- stranger or someone close

      • Stabbing, blunt trauma

      • Group trauma: terroism

• Environmental

  • • • Storm, hurricane, flooding, 

      • Occupational

History

• Blunt or penetrating trauma

• Time of impact

• Repeated or single impact

• Mechanism of injury

• Symptoms afterwards, i.e. headache

• Systemic enquiry: ?focal neurology/ cranial nerve damage

Examination

• Wound: size and depth

• Bruising

• Neck function 

• Full cranial nerve exam

Plan

• ?CT-H

• Likely d/c H with head injury advice

Diagnoses and complications

1. Concussion

2. Haematoma: subdural, extradural & intracranial

3. Death

Comments

The key decision for a head injury is whether to perform a CT-H. NICE provides the framework for guidance on indications for a CT-H. From my experience there is generally a low threshold for doing a CT-H and everyone feels more comfortable sending the person home after one has been done. 

Head injuries can be fatal. Of note are the 'one hit one kill' events that happen typically in clubs- two gentleman have a fight and one of them receives a heavy punch to the head. He feels ok and goes to bed and is found dead in the morning. A subdural haematoma typically produces a headache that improves during a lucid period before getting worse. Alcohol can prevent individuals from interpreting their symptoms rationally but also headaches are common as part of a hangover. 

Concussion is a nasty condition involving 6 weeks to 6 months of headaches, fatigue and irritability as the brain takes a long time to slowly recover. It is by some definition a functional diagnosis, as usually the CT-H is normal and no object signs can be found of disease.