Brain Injury Center

What is a head injury?

Head injuries are one of the most common causes of disability and death in children. The injury can be as mild as a bump, bruise (contusion), or cut on the head. Or it can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the child's head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

What is a concussion?

A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

What is a contusion?

A contusion is a bruise to the brain. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck.

What is a skull fracture?

A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following: Linear skull fractures - This type accounts for almost 70 percent of skull fractures. In a linear fracture, there is a break in the bone, but it does not move the bone. These children are usually observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. No interventions are usually necessary.

Depressed skull fractures - This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. Usually, this type of skull fracture requires surgical intervention to help correct the deformity.

Diastatic skull fractures - These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse with the growth of the child. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse with the growth of the child. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.

Basilar skull fracture - This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Children with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These children require close observation in the hospital.

What causes a head injury?

There are many causes of head injury in children. The more common injuries are falls, motor vehicle accidents (where the child is either riding as a passenger in the car or is struck as a pedestrian), or a result of child abuse. The risk of head injury is high in the adolescent population and is twice as frequent in males than in females. Studies show that head injuries are more common in the spring and summer months when children are usually very active in outdoor activities such as riding bicycles, in-line skating, or skateboarding. The most common time associated with head injuries is late in the afternoon to early evening hours, and on weekends.

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countercoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

What are the symptoms of a head injury?

• mild head injury
  • raised, swollen area from a bump or a bruise at the site of the blow
  • small, superficial (shallow) cut in the scalp
  • headache
• sensitivity to noise and light
• irritability
• confusion
• lightheadedness and/or dizziness
• problems with balance
• nausea
• problems with memory and/or concentration
• change in sleep patterns
• blurred vision
• "tired" eyes
• ringing in the ears (tinnitus)
• alteration in taste
• fatigue/lethergy
• moderate to severe head injury (that requires immediate medical attention) -symptoms may include any of the above plus:
  • loss of consciousness
  • severe headache that does not go away
  • repeated nausea and vomiting
  • loss of short term memory, such as difficulty remembering the events that led right up to and through the traumatic event
  • slurred speech
  • difficulty walking
  • weakness in one side or area of the body
  • sweating
  • pale in color
  • seizures or convulsions
  • behavior changes
  • blood or clear fluid draining from the ears or nose
  • one pupil (dark area in the center of eye) looks larger than the other eye
  • deep cut or laceration in the scalp
  • open would in head (the scalp contains many blood vessels and a cut or laceration due to trauma can be associated with substantional bleeding or blood loss.)
  • foreign object penetrating head
• coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
• vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation)
• locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)
   

How are head injuries diagnosed?

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Learn more about head injuries.