The following symptomatology is found in patients suffering in traumatic head injuries:

• General Appearance: Patients are usually brought to the emergency room with loss of consciousness due to severe brain trauma. Less severe cases can present with confusion, drowsiness and disorientation. 
• Head and neck: Headache and nausea is a usual symptom of increased intracranial pressure. Vision is usually blurred with tinnitus of the ear due to cranial nerve damage. 
• Chest and heart: Tachyarrhythmia may be caused by secondary subarachnoid bleeding due to traumatic brain injury.
• Abdomen: Intractable vomiting may be an outward sign of nausea. 
• Extremities: Spasticity and rigidity of all four extremities may be evident during significant cerebral and cerebellar injuries.
• Neurologic: Patients may present with dizziness and loss of balance due to cranial nerve impairment or damage to the middle ear. 

• Pain

  Drowsiness, high-grade fever, severe headache, left ocular pain with marked periorbital swelling, and paralysis of extraocular eye movements developed. [ncbi.nlm.nih.gov]

  Other symptoms include ringing in your ears, neck pain, or vision problems. These symptoms often go away in a few weeks, but may last longer if the injury is severe. [familydoctor.org]

  Third (eye) Vision Problems Fourth (eye) Vision Problems Fifth (face) Trigenial-injury can create an ultra painful condition in the face, usually an electrical type burst of pain on contact with the face. [braininjury.com]

  Glasgow Coma Scale Eye Opening Spontaneous 4 To loud voice 3 To pain 2 None 1 Verbal Response Oriented 5 Confused, Disoriented 4 Inappropriate words 3 Incomprehensible words 2 None 1 Motor Response Obeys commands 6 Localizes pain 5 Withdraws from pain [medicinenet.com]

• Unconsciousness

  Mild traumatic brain injury, also known as a concussion, either doesn’t cause unconsciousness or unconsciousness lasts for 30 minutes or less. [alz.org]

  An adult male had an accidental fall which rendered him unconscious. This was followed by diplopia and restricted ocular motility. He received supportive medical therapy. He was examined for systemic medical and ophthalmic findings. [ncbi.nlm.nih.gov]

  Severe head injury is usually defined as being a condition where the patient has been in an unconscious state for six hours or more, or a post-traumatic amnesia of 24 hours or more. [headway.org.uk]

• Fatigue

  Cognitive fatigue Cognitive fatigue is a common problem that can happen after a head injury. [rch.org.au]

  Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with [ninds.nih.gov]

  Common Symptoms of Mild TBI: Fatigue Headaches Visual disturbances Memory loss Poor attention/concentration Sleep disturbances Dizziness/loss of balance Irritability-emotional disturbances Feelings of depression Seizures Other Symptoms Associated with [traumaticbraininjury.com]

  Symptoms may include clumsiness, fatigue, confusion, nausea, blurry vision, headaches, and others. Mild concussions are associated with sequelae. [en.wikipedia.org]

  Get help right away if you notice the following: Any symptom that gets worse, such as headaches, nausea, or fatigue. Frequent vomiting. Drastic changes in behavior, such as anger or confusion. [familydoctor.org]

• Hunting

  The Low Country Boil will be provided by Hunt's Seafood and The Whiskey Dix will provide the live music! For tickets, please visit our Eventbrite site by clicking here. [ahif.org]

  Google Scholar Hunt T, Asplund C. Concussion assessment and management. Clin Sports Med. 2010;29:5–17. Google Scholar Kontos AP, Elbin RJ, Schatz P, Covassin T, Henry L, Pardini J, Collins MW. [doi.org]

  Hortobágyi T, Wise S, Hunt N, Cary N, Djurovic V, Fegan-Earl A. Traumatic axonal damage in the brain can be detected using beta-APP immunohistochemistry within 35 min after head injury to human adults. [emedicine.com]

• Inflammation

  Animal studies have shown that a head trauma typically causes inflammation in the brain, and this increases the risk of psychological symptoms. [sciencenordic.com]

  The growing evidence that head injuries increase the risk of non-Alzheimer’s dementia may be down to the effects of chronic brain inflammation caused by head trauma, says Faden. [newscientist.com]

  However, overall some initial inflammation may promote recovery, but prolonged or high levels of inflammation could be detrimental. [28, 29] For example, in severely brain-injured patients a group of CSF inflammatory mediators including intraleukin 6 [emedicine.com]

• Vomiting

  Any vomiting episodes since the injury (clinical judgement should be used in those aged ≤12 years). Any seizure since the injury. Irritability or altered behaviour, particularly in infants and young children. [patient.info]

  She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. [ncbi.nlm.nih.gov]

  Also take your baby to a doctor right away if he hits his head and in the next day or two he: Is vomiting. It's okay to have a bout of vomiting after a fall, but it shouldn't persist. [babycenter.com]

• Nausea

  She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. [ncbi.nlm.nih.gov]

  They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression. [headway.org.uk]

  Symptoms of bleeding in the brain, which may gradually worsen or suddenly appear, include: sudden severe headache seizures nausea or repeated vomiting lethargy weakness in an arm or leg loss of consciousness. [radiologyinfo.org]

  Head and neck: Headache and nausea is a usual symptom of increased intracranial pressure. Vision is usually blurred with tinnitus of the ear due to cranial nerve damage. [symptoma.com]

• Dysphagia

  […] authors report the rare and first documented case of concomitant microvascular decompression of trigeminal, facial and glossopharyngeal nerves for the management of intractable to medical therapy acute onset of trigeminal neuralgia, facial paresis and dysphagia [ncbi.nlm.nih.gov]

  Swallowing problems, called dysphagia. You may have trouble chewing or may cough and choke when you eat. Testing for TBI You should see a doctor or go to the emergency room if you have any type of head injury. [asha.org]

  […] nerve (CN) VI palsy: May indicate raised intracranial pressure CN VII palsy: May indicate a fracture of the temporal bone, particularly if it occurs in association with decreased hearing Hearing loss: Occurs in 20–30% of patients with head injuries [5] Dysphagia [emedicine.com]

• Blurred Vision

  She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. [ncbi.nlm.nih.gov]

  vision, or blind spots) Drainage of clear fluid (cerebrospinal fluid) from the nose or ear Severe headache [merckmanuals.com]

  Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with [ninds.nih.gov]

  […] child sustains an injury to the head, watch for these signs of a possible concussion: "seeing stars" and feeling dazed, dizzy, or lightheaded memory loss, such as trouble remembering what happened right before and after the injury vomiting headaches blurred [kidshealth.org]

• Tinnitus

  I suffer with intermittent bouts of depression, varying degrees of anxiety and paranoia, continuous headaches, with extreme light sensitivity, spontaneous loss of balance, motion sickness, and continuous severe tinnitus. [irlen.com]

  Huffing American Tinnitus Assoc: Ringing in the ears - Information, resources and support. Vestibular Disorders Assoc: Dizziness or Vertigo - Information, resources, and support. [headinjury.com]

  Vision is usually blurred with tinnitus of the ear due to cranial nerve damage. Chest and heart: Tachyarrhythmia may be caused by secondary subarachnoid bleeding due to traumatic brain injury. [symptoma.com]

  Problems with the senses : These may lead to: tinnitus, or ringing in the ears difficulty recognizing objects clumsiness, due to poor hand-eye coordination double vision and blind spots sensing bad smells or a bitter taste Coma : Patients who enter a [medicalnewstoday.com]

• Aggressive Behavior

  Difficulty with concentration Short-term memory loss Interference with long-term memory Aggressive behavior Change in sexual interest Persistent talking (damage to right lobe) Difficulty locating objects in environment. [headinjury.com]

  Aggressive Behaviors Provided a situation does not present a physical threat, various approaches may be used to diffuse hostile behavior: Remain as calm as you can; ignore the behavior. [caregiver.org]

  This research associates TBI with a range of psychiatric disorders, including depression and aggressive behavior. Hesdorffer, D. C., Rauch, S. L. Tamminga, C. A. (2009). [pbs.org]

• Headache

  The most common recognizable forms of posttraumatic headache in concussion are tension-type headache, cervicogenic headache, migraine, and combined tension-type headache and migraine. [doi.org]

  BACKGROUND: Headache is the most frequent symptom following head injury, but long-term follow-up of headache after head injury entails methodological challenges. [ncbi.nlm.nih.gov]

  They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression. [headway.org.uk]

  My headaches and feeling nauseous, motion sickness, and light sensitivity are instantaneously gone. I feel more relaxed, less strain and the Irlen lenses feel soothing and I feel a sense of calmness. [irlen.com]

• Seizure

  The child was admitted several times with breakthrough seizures. Over time the seizures became refractory to treatment. [ncbi.nlm.nih.gov]

  During follow-up, 97 patients had unprovoked seizures, of whom 22 had only one seizure and 75 had multiple seizures. Figure 1. Figure 1. [content.nejm.org]

• Confusion

  Level 4-- Confused/Agitated: Person is extremely agitated and confused. Level 5-- Confused-Inappropriate/Non-agitated: Person is confused and responses to commands are inaccurate. [msktc.org]

  Seems weak or confused, or seems to have problems with coordination, vision, or verbal communication. Can a concussion cause permanent brain damage? Only in rare cases. [babycenter.com]

  Effects of concussion are usually temporary, but can include altered levels of consciousness, headaches, confusion, dizziness, memory loss of events surrounding the injury, and visual disturbance. [rch.org.au]

  More than half (56%) screened positive for mTBI, defined as at least one instance in which they experienced a change in consciousness or a period of being dazed and confused as a result of a head injury. [ncbi.nlm.nih.gov]

  A traumatic brain injury (TBI) can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. [traumaticbraininjury.com]

• Dizziness

  They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression. [headway.org.uk]

  OBJECTIVE: We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular [ncbi.nlm.nih.gov]

  Initial symptoms might include dizziness, slurred speech, and amnesia. Signs Signs of concussion may not be noticeable straight away. [medicalnewstoday.com]

  People with minor head injuries may have a headache or dizziness. People with more severe head injuries may lose consciousness or have symptoms of brain dysfunction. Computed tomography is used to check for severe head injuries. [merckmanuals.com]

• Amnesia

  […] loss of consciousness and those with only amnesia. [content.nejm.org]

  Post-traumatic amnesia in a worker presenting with head trauma must be recognised by coworkers, so the cause of injury can be elicited early and the victim gets timely medical help. [ncbi.nlm.nih.gov]

  We include athletes who have lost consciousness for more than five minutes or experienced amnesia for more than 24 hours in the Grade 5 category. [brighamhealthhub.org]

  Concussion: symptoms of amnesia and confusion. Duration of amnesia is predictive of injury severity. Other symptoms include dizziness, headaches, poor concentration, nausea, and vomiting. [patient.info]

A comprehensive clinical history and a thorough physical and neurologic examination may be all that is needed to diagnose traumatic head injuries. The following laboratories and tests may be helpful in the diagnosis and management of the traumatic brain injuries:

• Glasgow Coma Scale: A 15 point scale that determines the level of consciousness of patients with head injury
• Intracranial monitoring device: Inserted in the skull to monitor the actual intracranial pressure
• Imaging: Computerized tomography can easily visualize skull fractures, intracranial bleeding, brain contusions, brain swelling and hematoma formation. Magnetic resonance imaging can demonstrate a more detailed view of the brain structures.

Mild traumatic head injury may not require any treatment. Patients are usually advised adequate rests and may be given pain relievers to treat symptoms of headache. However, patients sustaining severe head injuries with altered state of consciousness and unstable vital signs may need immediate emergency care.

Medical management with osmotic diuretics and anti-seizure drugs may be given to allay the symptoms of severe traumatic head injury. Medical decompression of the CSF using mannitol and vasopressors can maintain cerebral perfusion pressures to at least 70 mmHg ensuring undisrupted blood supply to important cortical structures [10].

Neurosurgical approaches to traumatic head injury include craniotomy and the removal of hematoma, primary repair of skull fractures, or burr hole craniotomy to relieve the pressure in the brain. Rehabilitation treatment with physiatrists, occupational therapists and neuropsychologists are an essential part of post-hospital and post-surgical care of patients.

In general, traumatic head injury prognosis worsens with the relative increase and extent of brain injury. Patients presenting at a Glasgow Coma Score (GCS) of 3 within the first 24 hours carries a 65% mortality rate [8]. The presence of subdural hematoma in patients with head injury varies inversely with the GCS score in terms of prognostic outcome and mortality rate [9]. The clinical condition of patients whether they are conscious and coherent or whether they are in a vegetative state may correlate closely with their prognosis.

Complications

Many complications can occur immediately or a few minutes after the traumatic head injury. The severity of the head injury increases the risk for permanent brain complications and more severe brain complications. The following complications are seen in patients suffering from traumatic head injuries:

• Altered state of consciousness
• Seizures or traumatic epilepsy
• Brain swelling
• Meningitis 
• Cerebral vascular damage
• Neuropathies
• Intellectual problems
• Communication difficulties
• Degenerative brain disorders

The following common events may result in traumatic brain injury among patients:

• Falls: This is the most cause on traumatic head injury in young adults and older patients. This includes falling in a flight of stairs, falling from a ladder, and slipping in a bath. 
• Vehicular accidents: This usually involves pedestrians colliding with motorcycling, bicycle, and automobiles. 
• Armed conflict: Domestic violence like gunshot wounds to the head represents 20% of all traumatic head injuries. 
• Sports injuries: Traumatic head injuries may be caused in certain sports like soccer, boxing, football, baseball, hockey and other high impact sports activities.
• Explosive blast or combat injuries: This type of injuries affects those in active military service especially those who sustain a grenade shrapnel injury or a blast from an explosive charge that damages the brain cells. 

In the United States, head injuries numbers to 1.5 million cases annually and three-fourths of which are classified as mild injuries. The relative incidence of head injuries in the Americas has reached 503 cases per 100,000 population with predominance among Native Americans. The incidence of elderly cases of traumatic injury deaths and hospitalizations in the United States has doubled that of the national average in 2003 [2].

In European countries, the rate of head injuries reaches a level of 91 cases per 100,000 cases annually. The exact incidence of traumatic injury may be hard to ascertain because patients who suffer brain dysfunctions with temporal amnesia will have difficulty in recalling the accounts of his head trauma in the emergency room [3].

The Center of Diseases and Control (CDC) has conveyed that more than 50,000 die each year due to traumatic head injuries and almost 100,000 incur permanent disability due to the said injury.

Afro-Americans races have an associated worse outcome of traumatic head injury compared to their white counterparts. There is a male preponderance for traumatic head injury in over two folds the risk compared to females worldwide. More than half of traumatic head injury worldwide is aged 24 years or younger.

The pathophysiology of traumatic head injury is conveniently divided into three brain insults namely: Structural traumatic insults, neurochemical insults, and secondary or indirect insults.

The structural traumatic insult includes incidences associated with the structural deformity of the skull like depressed skull fractures or a displaced skull fragment causing direct damage to the brain matter. The degree and extent of skull deformity may vary directly with the significance of the skull injury. The bridging cerebral vessels may be torn during the trauma which causes a subdural hematoma which may disrupt other cortical vessels in the brain. Trivial brain injuries may cause significant subdural hemorrhages in elderly patients [4].

Neurochemical insults correlates with surge of neurochemicals like catecholamine and hyroxyindole acetic acid (HIAA) in the cerebrospinal fluid (CSF) causing toxic effects to the brain tissues [5]. The initial brain trauma facilitates free radical release breaking down the lipid membranes of the neurons causing intraneuronal calcium accumulation and eventual cell death. Microdialysis of the CSF revealing the presence of excitotoxic aminoacids like glutamate and aspartate correlates with poor prognosis in traumatic head injuries [6]. Hypoxia and hypotension accounts for the majority of secondary insults associated with traumatic head injuries. Severe traumatic injury which halts the breathing centers of the hypothalamus may result to significant long-term or permanent brain injuries if oxygenation is not ensured at the site of the trauma during the rescue and extrication process [7].

The following helpful tips are most useful in the prevention of traumatic head injuries:

• Ensure the wearing of seatbelts when driving and make sure emergency airbags are working properly.
• Refrain from using alcohol or illegal drugs before driving. 
• Protective helmets may save one’s life when driving motorcycles and bicycles.
• Hand rails and nonslip mats may prevent accidents in the bathroom.
• Clear stairways of clutter and unnecessary obstruction.
• Install good lighting in the living quarters.
• Place shock absorbing material in children’s playground.

Head injury or traumatic brain injury happens when any external mechanical force to the head directly causes a temporal or permanent brain dysfunction. Head injury may also occur after a violent blow or jolt to the head or body part causing a penetrating injury to the skull like a projectile or a bullet.

Cerebral artery vasospasm may ensue as an immediate hemodynamic complication of traumatic brain injury causing intracranial hypertension in almost half of patients [1]. Serious traumatic head injury can result to brain bruising, torn tissues, and bleeding that may result to long standing complications or even death.

Definition

Head injury happens when an external mechanical force jolts the head causing temporary or permanent brain dysfunction.

Cause

Falls, vehicular accidents, armed conflict, sports injury and blast injuries are common causes. 

Symptoms

Altered state of consciousness, difficulty in respiration and rigidity may occur.

Diagnosis

Clinical examination and imaging studies like CT scan and MRI.

Treatment and follow-up

Mild traumatic head injury may not require any treatment. Medical decompression of the CSF pressure and neurosurgical treatment options may be necessary in more severe cases.

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