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Closed Head Injury

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Definition

A closed head injury is trauma to the head that causes the skull and brain to knock or shake. Internal damage can occur to the:

  • Skull
  • Brain
  • Blood vessels
  • Layers between the skull and scalp

This damage can cause swelling or pressure on the brain. The injury can be throughout the brain and skull or it may confined to 1 area.

Often times, the head injury is minor. However, it can serious and life threatening. It requires care from a doctor.

Causes

Closed head injuries are caused by trauma to the head. This is often due to:

  • Accidents (such as automobile, work-related, sports-related)
  • Falls
  • Abuse
Head Injury
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Risk Factors

Factors 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

Symptoms

Symptoms 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
  • Nausea
  • 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

Symptoms of a skull fracture or focal brain injury:

  • Leaking cerebrospinal fluid
  • Blood in the ears
  • Weakness or numbness of the limbs
  • Pain
  • Swelling, tenderness at injury site
  • Headache
  • Hearing loss
  • Progressive worsening of cognition or level of alertness

Be sure you know which symptoms your doctor needs to know about right away. If you have been evaluated for a closed head injury and your symptoms are getting worse, get medical help right away.

Diagnosis

You 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

Imaging tests evaluate the brain and other structures:

Imaging tests are not routinely done in children with minor head injuries. Your child may be observed to determine if imaging tests are needed.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment will depend on:

  • Your symptoms
  • Location and severity of the injury

Treatment options include the following:

Monitoring and Observation

For 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 Testing

You 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

Counseling

You may be referred to a counselor to take part in a rehabilitation program to improve functioning.

Medications

Medications can be used to:

  • Reduce pain
  • Reduce pressure inside the head or brain swelling
  • Prevent seizures (given in some cases)

Surgery

This 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.

Prevention

To 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.

Revision Information

  • American Academy of Neurology

    http://www.aan.com

  • Brain Injury Association of America

    http://www.biausa.org

  • The Brain Injury Association of Canada

    http://biac-aclc.ca

  • Ontario Brain Injury Association

    http://www.obia.on.ca

  • 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.