How Can I Tell If a Head Injury Is Mild or Severe?

Impact to the head can result in a number of types of head injuries, that can range in seriousness from mild to severe. 

• Skull fracture
  • A crack or break a bone in the skull 
  • Often causes bruising on the surface of the brain under the fracture
• Epidural hematoma
  • A serious form of bleeding that occurs when one a blood vessel under the skull is torn during an injury and bleeds
  • Blood collects in the space between the skull and the outermost of the membranes that cover the brain (a hematoma) and can press on the brain
  • Can be life-threatening
  • Skull is usually fractured as well
• Acute subdural hematoma
  • A blood vessel tears, and blood collects between the dura and the surface of the brain
  • Develops rapidly, often after serious head trauma caused by assault, motor vehicle accident, or fall
  • Very severe and fatal in about half of all cases
• Chronic subdural hematoma
  • Bleeding inside the skull happens slowly
  • May occur after a relatively minor head injury in a person who is elderly, who is taking blood-thinning medications, or who has alcoholism or dementia
• Intraparenchymal hemorrhages and contusions
  • A pooling of blood within the brain tissue
• Concussion 
  • A traumatic brain injury caused impact to the head or body that causes the head and brain to move around quickly

Head injuries are caused by bumps, blows, jolts or impact to the head from: 

• Motor vehicle accidents
• Falls
• Sports injuries or hits
• Bicycling accidents
• Beatings or other kinds of physical abuse

Head injuries are diagnosed with the patient's history, neurological assessment, metal status testing, and imaging tests.

A neurologic examination includes an assessment of:

• Cranial nerves III through VII (extraocular movements, pupillary reactivity, face sensation, and movement) 
• Limb strength 
• Coordination 
• Gait

Mental status testing may include assessment of: 

• Short-term memory 
• Attention 
• Concentration

Imaging tests used to diagnose a head injury include: 

• Computed tomography (CT) of the head
• CT angiography (imaging of the blood vessels) 
• Magnetic resonance imaging (MRI)
• X-rays

Treatment for a head injury depends on the type of injury and the severity. 

A skull fracture may not need treatment. Treatment for a skull fracture depends on the type of fracture and where it is and may include:

• Antibiotics to prevent infections
• Anti-seizure medicines 
• Vaccines to prevent certain serious or deadly infections
• Surgery

Treatment for epidural hematoma, acute subdural hematoma, chronic subdural hematoma, and intraparenchymal hemorrhages and contusions may include:

• Surgery 
• Craniotomy to remove the blood clot to lower pressure on the brain and stop bleeding 
• Burr hole drilled into the skull to allow the blood to drain 

Treatment for a small subdural hematoma may include:

• An implanted sensor inside the head to measure intracranial pressure 
• Medicines to control symptoms
• Repeated CT scans to watch the hematoma 
• Stopping blood thinners if you take them (never stop taking a prescribed medicine without first talking to your doctor)
• Vitamin K therapy 

A mild concussion may not need treatment. Most concussions get better on their own over time. Home treatment for a mild concussion includes:

• Rest your body and brain
  • Get plenty of sleep
  • Avoid too much physical activity 
  • Avoid activities that need concentration or a lot of attention 
• Avoid alcohol while symptoms are still present
• Over-the-counter (OTC) pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

Head injuries may be prevented by:

• Wearing a seatbelt when in a motor vehicle
• Never drive under the influence of alcohol or drugs
• Wear a helmet or appropriate headgear when on a bike, motorcycle, or playing sports 
• Prevent falls (important for elderly adults)
  • Get rid of household hazards such as loose electrical cords, slippery rugs, and clutter
  • Wear sturdy shoes
  • Avoid walking in unfamiliar and dark areas 
  • Have eyes checked regularly and keep corrective lens prescriptions up to date
  • Do strength and balance exercises 
  • Keep the home safe for children