Closed Head Injury: Discussion of Mild Head Injury - Case Study Example

Closed head injury – Case discussion of mild head injury Introduction Trauma to the head is known as head injury. It may or may not include brain injury. It may be open or closed. Open injury or penetrating injury occurs when an object pierces the skull and breaches the duramater. A closed head injury is one in which the skull is not broken. Head injury can affect brain due to swirling movements throughout the brain causing tearing of nerve fibers and widespread bleeding in and around the brain. This can further lead to raised intra-cranial pressure which can block the flow of oxygen to the brain. About 70% of all accidental deaths are due to head injuries. Closed head injury can occur due to direct blow to the head, sudden deceleration of the head without its striking another object or due to sudden stopping of the moving head. The extent of injury to the brain in closed head injury depends upon the impact, direction, force, and velocity of the blow. For example, in a moving head, the brain damage occurs on the side opposite the point of impact. This is known as ‘contrecoup injury’. In a resting head, the maximum damage will be found at the impact site. Case history 25 year old young man by name Thomas Claire was brought to the casualty on a Friday afternoon after sustaining head injury while playing foot ball. This injury occurred about 15 minutes prior to coming to hospital. His attendants reported that the injury occurred due to the ball hitting forcefully on his head, following which he fell down and became unconscious for a few minutes. On his way to hospital, he vomited once and was not oriented about what exactly happened. He did not have any seizures. On admission to emergency care, he was conscious and oriented. He complained of mild head ache, dizziness and nausea. Vital signs were stable. GCS was 15. Pupils were normal sized, symmetrical and reactive. There was no evidence of skull fracture, neurodeficit, or any other injury. He had no history of previous neurodeficit or neurosurgery or coagulopathy. A diagnosis of mild risk mild head injury was made and Thomas was kept in the casualty for observation for 4 hours. During these four hours, he was clinically stable. He had no further vomiting. At the end of 4 hours, his vital signs were stable, GCS was 15, pupils were normal and there was no neurodeficit. He was discharged with an advice to come back in case of any new developments like seizures, excessive drowsiness, confusion, abnormal behavior, irritability, seizures, blurred vision, slurred speech, severe head ache, persistent vomiting or abnormal clumsiness. He was advised to stay with a reliable attendant who should wake him up every 4 hours. He was also advised rest and paracetamol for head ache. These instructions were also told to the attendant. Also, he was advised not to consume alcohol or take any sedatives. He was asked to come after 48 hours for follow up. It has been 2 months since the injury and Thomas has returned to normal life. He developed post-concussion symptoms like mild head ache and irritability which resolved in few days. Case discussion The importance of head injury is that it can cause brain injury. This can be mild, moderate or severe. Those who have GCS of > 13 are said to have mild head injury, those with GCS 8-13 have moderate injury and those with GCS < 8 have severe injury (1). It is obvious that moderate and severe injuries need to be admitted and managed under the care of neurosurgical unit. When a person has mild head injury, the question is when to admit him for observation and when to discharge home? This is of utmost importance because; those who have mild head injury may worsen later if not assessed properly initially and sent home. Also, another question is when to get a CT Scan and when to simply observe? Various institutions have their own protocols regarding management of mild head injury. According to the NSW Institute of Trauma and Injury (2), those with mild head injury can be further divided in to Low Risk Mild Head Injury and High Risk Mild Head Injury. Those with GCS 15 at 2 hours post injury, no neurological deficit, no clinical suspicion of skull fracture, brief loss of consciousness ( Read More