Head Trauma

Head trauma can occur in very different settings. Prior to the introduction of seat belts it was common with automobile accidents.

Sports injuries, particularly contact sports, is often associated with a higher risk of head trauma. An infant may have been born with a difficult forceps delivery and there is a higher risk for head trauma as well. Boxing and assaults are also a frequent source of head trauma. It is important for the physician in the Emergency Room setting of a hospital to assess whether or not there is a skull fracture present, whether or not an intracranial bleed has occurred and whether or not there are other injuries associated with it like cervical spine fractures or vascular injuries around the neck and chest region.

Signs and symptoms:

The level of consciousness is assessed with the Glasgow coma scale, where a standard assessment is made with regard to level of responsiveness, muscle power, and eye muscle control.

The scale ranges between 3 and 15. A severe head trauma would be defined by a Glasgow scale of 8 or less 48 hours after the trauma (Ref. 6, p. 425). Often there may bleeding from the areas such as the ear canal or the nose. The physician would have a high index of suspicion for a basal skull fracture in these cases.

As mentioned under epidural hematoma there can be a lucid interval and then unconsciousness sets in. There might be a sudden bout of seizure and the diagnosis would be posttraumatic epilepsy. The symptoms are determined by the specific area of the head or the brainstem that is injured and the associated other injuries such as cervical spine fractures.

Diagnostic tests: The emergency physician and specialists such as neurologist and neurosurgeon will likely order emergency CT and/or MRI scans.

Other X-rays such as cervical spine x-rays are often needed. The other tests needed depend on the clinical presentation.

Treatment: A person with a severe head injury may need intubation and artificial respiration for a period of time until the level of consciousness and spontaneous breathing are normalizing. Hyperventilation can help to reduce the intracranial pressure via blood vessel constriction. Osmotically active intravenous substances such as mannitol can be utililized to reduce the intracranial pressure for 6 to 8 hours with every dose (Ref. 6, p. 428). Surgical decompression by placing burr holes neurosurgically may be required. Seizure prophylaxis and antibiotic prophylaxis may be necessary depending on the underlying injury (Ref. 6, p. 429).

Pain relief:

There is an FDA approved non-drug method available, IceWave patches from Lifewave, which will control pain. This is mentioned in the book "Breakthrough" by Suzanne Somers (Ref. 10) where newer insights of antiaging medicine are also reviewed. Although the patches are placed over acupuncture points, there are no needles involved. Nanotechnology, a newer technology, was used in the manufacturing of these patches and infrared (heat) waves from body heat are utilized to stimulate an acupuncture point, which modifies pain perception and reduces pain to half or less. Medically this would be considered an excellent pain reliever. For more info on the patches see the IceWave patches from Lifewave link above (click "products"). In the US a 5 pack of the IceWave spray is available that can be directly sprayed onto the skin in the area where the pain is located.

Here is a table that will assist you in case you would like to return to another neurological topic:

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Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company

2. B. Sears: "The top 100 zone foods". Regan Books, Harper Collins, 2001.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 176.

4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby, Inc.

5. Goroll: Primary Care Medicine, 4th ed.,2000, Lippincott Williams & Wilkins

6.Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998, Mosby-Year Book, Inc.

7. Ruddy: Kelley's Textbook of Rheumatology, 6th ed.,2001, W. B. Saunders Company

10. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: Dec. 23, 2008