Head Injury Health Article

Treatment

If a concussion, bleeding inside the skull, or skull fracture is suspected, the patient should be kept quiet in a darkened room, with head and shoulders raised slightly on pillow or blanket.

After initial emergency treatment, a team of specialists may be needed to evaluate and treat the problems that result. A penetrating wound may require surgery. Those with severe injuries or with a deteriorating level of consciousness may be kept hospitalized for observation. If there is bleeding inside the skull, the blood may need to be surgically drained; if a clot has formed, it may need to be removed. Severe skull fractures also require surgery. Supportive care and specific treatments may be required if the patient experiences further complications. People who experience seizures, for example, may be given anticonvulsant drugs, and people who develop fluid on the brain (hydrocephalus) may have a shunt inserted to drain the fluid.

In the event of long-term disability as a result of head injury, there are a variety of treatment programs available, including long-term rehabilitation, coma treatment centers, transitional living programs, behavior management programs, life-long residential or day treatment programs and independent living programs.

Prognosis

Prompt, proper diagnosis and treatment can help alleviate some of the problems after a head injury. However, it is usually difficult to predict the outcome of a brain injury in the first few hours or days; a patient's prognosis may not be known for many months or even years.

The outlook for someone with a minor head injury is generally good, although recovery may be delayed and symptoms such as headache, dizziness, and cognitive problems can persist for up to a year or longer after an accident. This can limit a person's ability to work and cause strain in personal relationships.

Serious head injuries can be devastating, producing permanent mental and physical disability. Epileptic seizures may occur after a severe head injury, especially a penetrating brain injury, a severe skull fracture, or a serious brain hemorrhage. Recovery from a severe head injury can be very slow, and it may take five years or longer to heal completely. Risk factors associated with an increased likelihood of memory problems or seizures after head injury include age, length and depth of coma, duration of post-traumatic and retrograde amnesia, presence of focal brain injuries, and initial Glasgow Coma Scale score.

Prevention

Many severe head injuries could be prevented by wearing protective helmets during certain sports, or when riding a bike or motorcycle. Seat belts and airbags can prevent many head injuries as a result of car accidents. Appropriate protective headgear should always be worn on the job where head injuries are a possibility.

BOOKS

Greenberg, David A., et al. Clinical Neurology. 2nd ed. Norwalk, CT: Appleton & Lange, 1993.

Weiner, William J. Neurology for the Non-Neurologist. 3rd ed. Philadelphia: J. B. Lippincott, 1994.

PERIODICALS

Mild Traumatic Brain Injury Committee. "Definition of Mild Traumatic Brain Injury." Journal of Head Trauma Rehabilitation 8 (1993): 86-87.

Soren, S. and Kraus, J.F. "Occurrence, Severity and Outcomes of Brain Injury" Journal of Head Trauma Rehabilitation 6(1991):1-10.

ORGANIZATIONS

American Epilepsy Society. 638 Prospect Ave., Hartford, CT 06105. (203) 232-4825.

Brain Injury Association. 1776 Massachusetts Ave. NW, Ste. 100, Washington, DC 20036. (800) 444-6443.

Family Caregiver Alliance. 425 Bush St., Ste. 500, San Francisco, CA 94108. (800) 445-8106. <http://www.caregiver.org>.

Head Injury Hotline. PO Box 84151, Seattle WA 98124. (206) 621-8558. <http://www.headinjury.com>.

Head Trauma Support Project, Inc. 2500 Marconi Ave., Ste. 203, Sacramento, CA 95821. (916) 482-5770.

National Head Injury Foundation. 333 Turnpike Rd., South-boro, MA 01722. (617) 485-9950.

Carol A. Turkington

KEY TERMS

Computed tomography scan (CT)—A diagnostic technique in which the combined use of a computer and x rays produce clear cross-sectional images of tissue. It provides clearer, more detailed information than x rays alone.

Electroencephalogram (EEG)—A record of the tiny electrical impulses produced by the brain's activity. By measuring characteristic wave patterns, the EEG can help diagnose certain conditions of the brain.

Magnetic resonance imaging (MRI)—A diagnostic technique that provides high quality cross-sectional images of organs within the body without x rays or other radiation.

Positron emission tomography (PET) scan—A computerized diagnostic technique that uses radioactive substances to examine structures of the body. When used to assess the brain, it produces a three-dimensional image that reflects the metabolic and chemical activity of the brain.