Firstly, regarding brain damage in head injuries.

When people talk about head injuries, they are usually talking about signs of thumped and jarred  brain (concussion) or intracranial haemorrhage.

Brain concussion symptoms follow being knocked out by the injury. One major indication of the severity of the injury is how long the person was unconscious for.
If you are present then, try to measure this if possible.

If a child is unconscious for more than 30 seconds, it is considered a sign of possible severe injury.

After recovery of consciousness, the concussion syndrome may include repeated vomiting, continual headache, convulsions, irritability and difficulty concentrating.


If the injured person feels like sleeping, it is better to sleep, but someone should be there to wake them up every 4 hours the first night, to ensure they are capable of waking fully.

Driving, strenuous activity, alcohol and drugs other than paracetamol (acetaminophen) are best avoided for a couple of days.

Any mental activity can apparently delay recovery┬╣. Screen rest is needed - curtail use of phones, tablets etc.




Intracranial haemorrhage here mostly means bleeding under the skull bones, which presses down on the brain.
This is different to bleeding in the brain, as in a haemorrhagic stroke.

This produces a post concussive syndrome, which used to be called "delayed concussion." It is caused by compression of the brain, and is very serious. It often needs urgent surgery to release the pressure.

(Swelling of the brain itself can happen with very severe head trauma, but this is when the person is already in hospital.)

The person now becomes more drowsy and can get confused, unequal eye pupils, slurred speech, weakness of one side and more severe headache.


Skull fracture is needed for this to happen in a young person, and it is caused by the fracture tearing an artery, so occurs within a few hours of the injury.

This is an extradural bleed, outside of the tough dura bag which surrounds the brain.
Subdural collections are due to a vein tearing, inside the dura bag. They can show up even three months after even mild head injuries, in elderly people (in whom they can happen without a skull fracture.)


CT scan of the head has revolutionized this area of medicine. It allows one to see inside without drilling.
I had a nickname "burr holes Jim" when a junior intern, because I'd drilled holes in the skull of a person with severe head injuries. The person didn't have an extradural haemorrhage, but at least we knew this from the burr holes.
A country family doctor in my state recently did the same and saved a persons life.


Please have your neck checked

When someone is severely head injured and has to be shifted, everyone knows to be very careful of their spine in case they have a fractured vertebra.

In less severe head trauma, it is very common to have put a joint or more "out" in the neck.

Please get a check from someone competent to examine each of the joints separately, to ensure none is " hitched " and immobile.

This includes the difficult to examine atlanto-occipital and atlanto-axial joints at the top of the neck.

The next four weeks after the injury.

It is common to feel more tired, so get enough sleep.

Ask someone close to you whether you are behaving normally or not.
If there is any question of difficulty with concentration, remembering things, irritability, making decisions etc, don't drive.

Children may be better starting school for half days.

Repeated concussions in a short space of time, can produce progressively worse effects. Don't risk another head injury.

Children should get back to school before they get back to sport.


Return to sport

Once symptom free start with light exercise (walking, swimming or stationary cycling,) then light non-contact training. Provided these do not produce any symptoms, one can progress to more intense training and then full contact training.

Any return of symptoms at any stage means back off until better.

See reference 4 for further reading.


Eye movement delay is used to detect concussion damage.

Imaging with CT and MRI can't show concussion, which is disturbance of function. Dr. Uzma Samadani's group used equipment to track people's pupils as they followed a moving point on a screen, to see if either eye's movement was delayed.

There was a statistically significant difference between the healthy and brain-injured groups.

Dr. Samadani's² company, Oculogica, makes this EyeBox equipment.

Tests of visual fields ditto.

An optician in my home town uses perimetry to detect and chart progress of brain injury. It can show up as irregular scotomata in the peripheral vision.

Chemical markers of neuronal injury

These include a proteolytic fragment of alpha-II spectrin3 (SNTF,) amyloid precursor protein (APP,) non-phosphorylated neurofilament-H (SMI-32,) neurofilament-68 (NF-68) and compacted neurofilament-medium (RMO-14.) This is pretty much a "watch this space" ad, for you to check on using your favorite search engine. It will be certainly used more in the future.


SCAT-3 and CHILD SCAT-3 for ages 5-12

Parents and teachers involved with children playing sports ideally should be familiar with these assessment tools.
SCAT-3 for 13 yrs and over
CHILD SCAT-3 for ages 5-12 yrs


References

1. http://pediatrics.aappublications.org/content/early/2014/01/01/peds.2013-2125.abstract
2. http://neurosurgery.med.nyu.edu/about-us/our-team/our-physicians/uzma-samadani-md-phd




From head injuries back to main home page


3. http://link.springer.com/article/10.1007/s00401-015-1506-0

4 http://sma.org.au/resources-advice/concussion/



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