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Heads-up: What you need to know about head injuries

Today marks World Head Injury Awareness Day, a day dedicated to the prevention of head injuries. Head or brain injuries may be as mild as concussion or as debilitating as severe brain injuries. Dr Robyn Holgate, ER24’s Chief Medical Officer, answers some questions around misconceptions people might have when it comes to head injuries or brain damage.

1.Does a head injury always cause brain damage?

The difference between brain versus head injury is really a matter of semantics, and the terms are relatively interchangeable in medicine, however not all injuries to the head will result in injuries to the brain (this is rare). For example, a laceration to the scalp does not always manifest as a more serious injury to the brain. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. Brain injuries can result in physical, cognitive and behavioural symptoms, and the outcome can range from complete recovery to permanent disability or death. They may be minor, moderate or severe.

2. Can whiplash injuries cause brain damage?

Whiplash is widely regarded as a soft tissue injury of the neck with symptoms such as neck pain and stiffness, headaches, dizziness, visual symptoms, and weakness. Patients suffering from whiplash are at an increased risk of experiencing concurrent brain injury which can occur with or without a direct impact to the head. The symptoms are very similar; thus any patient experiencing these symptoms following a sudden and violent movement to the head should seek medical attention. This can be a movement forward, to the rear, and/or to the side. It may be the result of head-to-tail or side impact with a motor vehicle, following contact sports or a fall.

3. Can head injuries cause brain damage even if a person doesn’t lose consciousness?

Loss of consciousness is one (frequent) symptom which may present if a person has a head injury. It is a reliable indicator of severity for medical personnel, but certainly not the only symptom the public should worry about. There may be other symptoms such as a headache that gets worse and does not go away, weakness, numbness or decreased coordination, repeated vomiting or nausea and slurred speech. Brain injury often presents with symptoms related to the functions of the damaged focal area. An example would be the frontal area that is involved in social behaviour, emotion regulation, olfaction, and decision-making, hence the common social/emotional and judgment deficits following moderate-severe brain injury. In some bleeds on the brain, which may collect rapidly, the patient could be talking and suddenly deteriorate to unconsciousness.

4. How susceptible is a person who’s had one brain injury to suffer another one?

It’s critical that every patient who has experienced a brain injury, even a mild concussion, allows their brain time for symptom relief and “brain rest”, as the brain is very sensitive following an insult. A second insult may result in a more serious injury to the brain. Even after symptoms resolve entirely, people should gradually return to their daily activities. Brain functionality may still be limited despite an absence of outward symptoms. There are guidelines for safe return to normal activities, ask your doctor for advice if needed. Preventing future concussion/brain injury is critical as the rate of recovery from a second or third incident is generally slower.

5. How to recognise a head injury?

  • a loss of consciousness
  • convulsions or seizures
  • repeated vomiting
  • slurred speech
  • weakness or numbness in the arms, legs, hands, or feet
  • agitation
  • loss of coordination
  • dilated pupils
  • inability to wake up from sleep
  • severe headaches

6. Typical difference between a minor head injury and a serious brain injury?

Some doctors classify head injuries into three categories, based on symptoms:

Mild head injury — There is minimal injury to the outside of the head, with no (or brief) loss of consciousness. The injured person may vomit once or twice and complain of a headache.

Moderate head injury — There is a more obvious injury to the head, and the person may present with confusion and an altered level of consciousness. Other symptoms can include dizziness, drowsiness, nausea and vomiting, and seizures.

Severe head injury — There is serious damage to the brain, often together with other injuries to major body organs. In most cases, the person is unconscious or barely responsive.