Head Injuries 101

This article was written by expert contributor Dr. Manuel Momjian, founder and lead physician at Urgent 9.

 

Our brain is the most important part of our body, functioning as our control center and personality generator. We only have one brain, and so far repairs to the brain are still in the realm of science fiction. Unfortunately traumatic brain injuries are common, and knowing when to seek help and when to wait it out can be confusing. If you are in doubt, I recommend that you seek medical attention.

Imagine miscalculating a step, which causes you to trip forward on a concrete staircase. Your brain does not have time to stop and think about the safest way to land. Instead, we have an automatic response to a potential head injury: without thinking about it, we outstretch our arms and use our wrists as the first impact to the floor. This is arguably the reason that wrist fractures are some of the most common fractures that we might sustain. We instinctively sacrifice our appendages to prevent any injury to our head — and more importantly, our brain.

Our head is designed to protect our brain from trauma. The bony skull gives the brain rigid support and protection from blunt or penetrating trauma. The brain is further protected and enveloped by three thin layers called the meninges, which are cushioned by cerebrospinal fluid, and function as a shock absorber of the brain. With most mild head injuries, our body’s protective mechanisms are enough to withstand injury to the brain. But if the trauma to the head is great enough, there is risk of a traumatic brain injury.

The Center for Disease Control and Prevention (CDC) defines a traumatic brain injury as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.”

So how do we know if an injury is significant enough to cause damage to the brain? When do we obtain imaging of the brain, and when do we wait it out? These are difficult questions because some individuals with head injuries might look and act normal before they begin to decompensate. Waiting too long can increase the complications of dangerous brain bleeding. The decision to get imaging of the brain depends on many factors and should be made by a physician that is comfortable with the diagnosis and treatment of traumatic brain injuries.

When considering the need for imaging, I think it is best to separate out patients who are elderly or over 65 years old. These patients commonly sustain head injuries from accidental falls at ground level, usually while in their homes. A minor head injury to an elderly person can have fatal consequences because these individuals are at higher risk of dangerous brain bleeding. As the brain ages, there are changes to the structure and vasculature that increase the risk of bleeding. Also many elderly patients are taking medications that thin out their blood, making their risk of bleeding even higher. Another complication is that some elderly individuals will not appear sick and most will feel normal in the early stages of injury. So, all bets are off when we are dealing with an elderly patient who hits their head. Even minor head trauma with no physical findings may result in significant brain bleeding. So, I recommend those over 65 years of age have a medical evaluation that includes imaging to rule out brain bleeding, no matter how mild or insignificant the head injury.

Active teens and young adults that play contact sports are also frequent victims of head injuries. The most common head injury seen in this group is a concussion, or a mild traumatic brain injury. During the initial evaluation of a head injury, a physician will assess the need for neuroimaging based on risk factors such as; loss of consciousness, vomiting, headache, neurological changes, and the mechanism of injury. Imaging will determine if a symptomatic patient has a concussion or more dangerous brain bleeding that might require further neurosurgical intervention. With a concussion there is no brain bleeding and most patients will improve with rest. It is believed that concussions are caused by the brain being slapped against the inside of the skull with acceleration/deceleration trauma. The damage to the brain is microscopic. Recovery from a concussion is variable and depends on the extent of the injury. Some patients can have concussive symptoms that resolve within hours, and others may have months of symptoms including cloudy headaches and difficulty concentrating. The most important recommendation for someone who had a concussion is to avoid repeat head injuries because sudden death has been seen in recurrent head injuries within short period of time.

Previously, most head injuries would be referred directly to your closest emergency room. But with CT scanning becoming more accessible outside of a traditional hospital structure, people now have options regarding going to a hospital emergency room vs outpatient urgent care center. Be careful because most urgent care facilities do not have CT imaging. Currently Urgent 9, Urgent Care Center is the only urgent care in the Glendale area with these capabilities. For serious head trauma, we recommend that you call 911 to transport critical patient directly to a level one trauma center.