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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 bone may not be broken there can be small fractures. The trauma can also cause damage to soft tissue. The brain can hit the inside of the skull, and other soft tissue can tear, swell, and bleed.

This type of trauma may lead to traumatic brain injury which can cause a range of symptoms. Brain injury may be caused by the initial damage or secondary injury. Bleeding and swelling can cause an increase of pressure inside the skull. 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 hte head, neck or body. The most common traumas associated with head injuries include:

  • Accidents (such as automobile, work-related, sports-related)
  • Falls
  • Abuse
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, such as shaken baby syndrome
  • 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 help measure current level of symptoms and mark any improvement or worsening.

A CT scan may be done if there are severe symptoms or certain risk factors.

Treatment

Treatment will depend on the location and severity of the injury and specific symptoms.

Treatment options include the following:

Minor (Mild) Injury

Minor injuries have few or no symptoms. Watching for worsening or new symptoms in the days and weeks after the injury may be all that is needed. A designated person may be needed to make the observations in case symptoms make it difficult to act.

Activity may need to be adjusted during recovery depending on the pain or discomfort. Medication may help manage pain.

Moderate or Severe Injury

Immediate emergency care is required for head injuries with significant symptoms. Emergency care will help to:

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

Medication may be needed to manage the injury or symptoms such as:

  • Reducing brain swelling
  • Preventing seizures (given in some cases)

The brain sits in an enclosed pocket made of protective tissue, a fluid called the CSF, and the skull. The sudden addition of fluid like 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, so the pressure can continue to build in the brain. 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 your brain is recovering. It can take months or years for complete recovery of all symptoms though they should gradually improve during this time. 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.

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

  • 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.
  • 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.

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.

  • 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.