Each year, more than one-third of Americans over age 65 fall. Although hip fracture is a well-known consequence, few people are aware of the seriousness of a blow to the head.
Especially in older adults, a head injury—whether it occurs during a fall, a car accident or a sports activity—can trigger potentially deadly bleeding inside the skull. That’s because the brain shrinks as we age, increasing tension on the bridging veins, which run from the brain’s surface to its outer lining (dura). As a result, the bridging veins become more vulnerable to rupture. The situation is often worsened by the use of blood thinners, which are commonly prescribed to help prevent heart attack and stroke. An estimated 50,000 Americans die each year as a result of head injuries.
Caution: It can be difficult to determine the seriousness of a head injury from outward signs alone. For example, bleeding inside the skull may not cause symptoms until days, or even weeks, after the head injury occurred.
Red flags: Increasing sleepiness, a severe headache that keeps getting worse, confusion, difficulty walking, impaired memory, slurred speech, blurred vision and/or vomiting.
Important: People who have suffered a minor head injury don’t necessarily have to see a doctor —but they should get to an emergency room immediately if any of the above symptoms occur…even if it’s days after the injury.
Main types of head injuries…
A skull fracture is a break in the skeleton of the head (skull) and typically is caused by a fall or a car accident. A skull fracture is among the most dramatic-looking head injuries because it may be accompanied by copious external bleeding.
In most cases, however, a skull fracture isn’t very serious as long as there isn’t an accompanying brain injury and/or bleeding. In fact, a skull fracture may protect the brain. When the skull fractures during an accident, it absorbs part of the blow, and less of the trauma reaches the brain itself.
Physical signs of a skull fracture include bruises around the eyes (raccoon’s eyes) or behind the ears or the leaking of clear cerebrospinal fluid from the nose or ears.
Treatment: Many skull fractures heal on their own. Hospitalization may be required for overnight observation. Patients also may be given imaging tests, such as a computed tomography (CT) scan, to check for bleeding inside the skull.
A concussion is a head injury that does not cause visible physical damage and is often characterized by headache, confusion and/or amnesia. The brain damage that occurs—which is thought to involve disruptions in blood flow or nerve impulses, or temporary damage to axons (nerve fibers)—may not show up on CT scans or other imaging tests. Doctors rely on a medical history and the concussion symptoms listed above to make a diagnosis.
Most concussions are caused by a fall, car accident or athletic injury. Patients usually recover completely within a few hours—or, at most, a few days.
Treatment: Anyone with concussion symptoms following a blow to the head should get to an emergency room, especially if there is any loss of consciousness, confusion or memory loss.
The patient probably will be given a CT scan to check for bleeding in the skull or brain. If the test is normal—and most are—the patient will be advised to avoid strenuous physical activity, such as heavy lifting or climbing stairs, for a few days to aid healing of the brain. Acetaminophen (Tylenol) is prescribed for pain.
Contusions (bruises) and lacerations (tears) of brain tissue are potentially more serious than a concussion. Both contusions and lacerations may be caused by a sudden blow to the head, which often occurs during a fall, physical assault or when the head moves very rapidly, causing the brain to hit the inside of the skull, such as often occurs in a car accident.
Symptoms may include severe headaches, dizziness, vomiting, irritability, agitation and/or confusion.
Minor contusions/lacerations usually clear up on their own within a few days. Warning: Patients who experience severe, persistent headache, decreased alertness or consciousness, weakness in a limb, or one pupil larger than the other may have sustained a serious brain injury and should get immediate attention.
Treatment: Emergency surgery will probably be required if the CT or magnetic resonance imaging (MRI) scan shows significant bleeding/bruising, and the patient is also exhibiting the neurological symptoms described above. The surgeon will make an incision in the skull over the area of the injury. He/she will remove damaged brain tissue, along with any blood/fluids that may be present, to reduce brain swelling and pressure inside the skull.
An intracranial hematoma occurs when blood accumulates inside the brain or in the area between the brain and the skull due to an injury.
With a hematoma, the brain may be injured by the pressure caused by a blood accumulation (clot). This pressure can cause neurological problems, such as seizures, visual problems and/or weakness in a limb. Additional symptoms of an intracranial hematoma, including headache, loss of consciousness and one dilated pupil, are similar to those caused by other head injuries.
Treatment: Small hematomas, which can be detected by MRI or CT scans, often clear up on their own without subsequent treatment. Patients with larger hematomas, however, may require emergency surgery to stop bleeding and remove blood that could increase pressure on the brain.
