Overview

Almost everyone in his or her lifetime sustain some form of trauma to the head. Elderly, babies, and those with problems such as alcohol abuse, anti-coagulants therapy is especially prone to serious consequences after a head injury.

In Singapore, head injury is the leading causes of disabilities and deaths in adults under 40 years of age that have significance impact on the brain-injured patient, family and society.

Types of Head Injury

Head injury can be mild to severe in nature, and damage to the brain may occur immediately at the time of injury, or develop after the injury due to swelling or further bleeding. The common types of head injury include:

• Scalp injury – refers to the bump, cuts and lacerations of the scalp. Treatments include cold compression and suturing.
• Skull fracture – refers to the break or crack in the skull bone.
  • Linear skull fracture – Treatment is usually conservative as it does not cause many problems.
  • Depressed skull fracture is caused by direct impact onto the skull, which caused the shattered bones to be pushed into the brain. Antibiotics and surgery to prevent further brain injury, bleeding and infection may be needed.
• Concussion – is a "shake" to the head. . Most people recover without any permanent damage. Symptoms such as headache, giddiness, nausea, vomiting etc may persist, but will get completely better over time. Treatments include medications for symptom relief and adequate rest.
• Contusion – is a "bruise" that may cause tissue damage and bleeding.
• Haematomas (Blood Clots) – refers to the collection of blood in one or several locations of the brain. Treatments for contusion and haematomas include observation for worsening of symptoms to removal of blood clots. Prognosis depends on the type, size and effect of the lesions on the brain.

Causes

In Singapore, head injury occurs most commonly after motor vehicle accidents, falls at home or at work, acts of violence, sports and recreational injuries.

Symptoms

Varying degrees of symptoms including temporary or permanent loss of consciousness, nausea, vomiting, headache, giddiness, and loss of memory may appear associated with the severity of the head injury. The signs and symptoms of a head injury may occur immediately or develop slowly over several hours to days.

Even if no serious injury is found, careful watching with a responsible adult either at home or hospital must occur in the first 24-48 hours after the injury.

For the 1st 24 hour after a head injury, the person SHOULD NOT:

• Be left alone
• Drive a vehicle or operate machinery
• Take alcohol or any medications that can cause drowsiness

Call for help or go to the emergency department if:

• Any symptoms is getting worse e.g. sleepiness, headache, vomiting, dizziness
• Changes in behaviour e.g. irritability, confusion
• Weakness or numbness in the arms or legs
• Trouble walking or talking
• Fits or seizures

Diagnosis

X-ray may be performed to detect any fracture. CT scan of the brain may be ordered if the doctor thinks that there is risks of acute bleeding that can cause life-threatening problem.

The Glasgow coma scale (GCS) based on the sum of scores in 3 areas of assessment: eye opening, verbal and motor response, is a tool frequently used in hospital to grade the severity of the head injury that influences treatment decisions and outcomes.

Severity of head injury can be classified as:

Treatment Options

Treatment is individualised, depending on the degree and extent of injuries. It ranges from observation for signs of worsening such as drowsiness, increasing headache or giddiness (minor head injury) to removal of the blood clot in the brain to relieve the pressure in the brain (cause by the blood clot) or insertion of a brain pressure monitor (severe head injury).

Treatments for most minor head injuries include symptom relief and adequate rest.

Outcome and Complications

This depends in the type, location and degrees of injury. People with a minor head injury may have concussion syndromes such as slight headache, giddiness, easily tired, decreased concentration etc that may persist for a while, but most recover with no permanent problems. After a severe head injury, one-third make good recovery, one-third is left with varying degrees of disability, and the rest do not survive.