Closed Head Injury
(Traumatic Brain Injury)
DefinitionA closed head injury is trauma to the head that causes the skull and brain to knock or shake. Internal damage can occur to the:
- Blood vessels
- Layers between the skull and scalp
CausesClosed head injuries are caused by trauma to the head. This is often due to:
- Accidents (such as automobile, work-related, sports-related)
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Risk FactorsFactors 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
- Previous head injury or concussion
- Alcohol or drug abuse
SymptomsSymptoms can appear right away, or the days and weeks following the injury.Concussion symptoms include:
- Confusion, loss of memory about the accident
- Low-grade headache or neck pain
- Having trouble remembering, paying attention, organizing, making decisions
- Slowness in thinking, acting, speaking, or reading
- Feeling fatigued or tired
- Change in sleeping pattern, such as sleeping longer or having trouble sleeping
- Loss of balance or lightheadedness
- Increased sensitivity to sounds, light, or distractions
- Blurred vision or eyes that tire easily
- Loss of sense of taste or smell
- Ringing in the ears
- Feeling sad, anxious, or listless, lacking motivation
- Becoming easily irritated or angry for little or no reason
- Leaking cerebrospinal fluid
- Blood in the ears
- Weakness or numbness of the limbs
- Swelling, tenderness at injury site
- Hearing loss
- Progressive worsening of cognition or level of alertness
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a neurologist for special testing.Tests may include:
- Blood tests
- Neurological examination
- Neuropsychological tests
- Electroencephalogram (EEG)—to evaluate electrical activity in the brain
TreatmentTalk with your doctor about the best treatment plan for you. Treatment will depend on:
- Your symptoms
- Location and severity of the injury
Monitoring and ObservationFor minor injury with little or no symptoms, your doctor may advise that you watch for symptoms to develop in the days and weeks that follow.If you have a concussion, a responsible adult will need to observe you. You may also need to limit drug and alcohol use.
Neuropsychological TestingYou may need more testing. These tests assess how your brain functions. The results can help your doctor determine:
- How you are recovering
- Whether you are ready to return to high-impact activities
CounselingYou may be referred to a counselor to take part in a rehabilitation program to improve functioning.
MedicationsMedications can be used to:
- Reduce pain
- Reduce pressure inside the head or brain swelling
- Prevent seizures (given in some cases)
SurgeryThis usually involves making “burr holes” in the scalp and skull and draining the clotting blood. Sometimes a section of the skull is removed to relieve pressure. This is called a craniotomy .
PreventionTo help reduce your chance of a closed head injury:
- Do not drink alcohol and drive.
- Do not take medications that may make you sleepy, especially when driving or using heavy equipment.
- Obey speed limits and other driving laws.
- In vehicles, always use seatbelts, shoulder harnesses, and child safety seats. Only use child safety seats when traveling. Do not use them outside of the vehicle.
- Learn about the air bags in your car.
- 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.
- Make sure your child's play surface is soft and free of rocks, holes, and debris.
- Reduce falling hazards at home for children and adults, by:
- Using handrails when walking up and down stairs
- Having safety gates by stairs and safety guards by windows
- Using grab bars in the bathroom
- Placing non-slip mats in the bathroom
- Keeping walkways clear to avoid tripping
- Making sure rooms and hallways are well-lit
- Keep firearms and bullets locked safely away.
American Academy of Neurology
Brain Injury Association of America
The Brain Injury Association of Canada
Ontario Brain Injury Association
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.
- Reviewer: Michael Woods, MD
- Review Date: 12/2014
- Update Date: 12/20/2014