Concussion (head injury)

Head | Emergency Medicine | Concussion (head injury) (Disease)


The brain is a soft and delicate organ. A hard blow to the head can injure the brain or spinal cord even when there are no visible signs of trauma to the scalp or face. That’s why all head injuries are considered serious and you should consult with your doctor or nearest hospital emergency department.

Head injuries are classified as: Open – having bleeding wounds to the face or head ; Closed – having no visible signs of injury to the face or head.

A closed head injury is where the dura mater remains intact. The skull can be fractured, but not necessarily. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area.

Apart from wounds, other symptoms of serious head injury can include:

(1) Skull deformities – compressions or deformities are signs of fractures.

(2) Altered consciousness – for example, the person may lose consciousness for short or longer periods or may be conscious again but confused or drowsy.

(3) Vision changes – the pupils of the eyes may be dilated to different sizes in a person with a serious head injury. The person may complain of double or blurred vision.

(4) Black eyes and bruised skin behind the ears – this indicates that the force of the blow was sufficient to rupture blood vessels around the eyes and ears.

(5) Clear fluid from the ears or nose – a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.

(6) Nausea and vomiting – these are common side effects of serious head injury.

Causes and Risk factors

A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. There may be no other visible signs of a brain injury although you may see cuts or bruises on the head or face.

Diagnosis and Treatment

A history and physical exam will be performed in order to diagnose the type of the concussion. A CT scan and/or MRI will be done to rule out traumatic brain injury.

Treatment includes: prevention of further head trauma, pain medications, nonsteroidal anti-inflammatory medications/NSAIDs, acetaminophen and/or anti-nausea medications. It is very important to prevent a second injury before the symptoms of the first concussion have resolved to avoid the potentially serious consequences of second impact syndrome.


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