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Closed Head Injury

(Traumatic Brain Injury; Head Trauma)

by Cynthia M. Johnson, MA
En Español (Spanish Version)
Definition
Causes
Risk Factors
Symptoms
Diagnosis
Treatment
Prevention

Definition

A closed head injury is trauma to the head that does not cause a break in the skull. The brain and soft tissue can be damaged by violent movement. This can lead to bleeding and swelling inside the head.

Causes

This problem is caused by a blow to the head or severe jerking motions of the head, neck, or body. Common causes are:

  • Accidents, such as motor vehicle, work- and sports-related accidents
  • Falls
  • Abuse, such as shaken baby syndrome

Head Injury
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Risk Factors

Falls raise the risk of this problem in older adults. Other things that may raise the risk are:

Symptoms

A person may have problems right away or in the days and weeks after the trauma. Problems may be:

  • Headache
  • Nausea and vomiting
  • Lightheadedness
  • Feeling very sleepy
  • Weakness or numbness in arms or legs
  • Problems with memory or focus
  • Double or blurry eyesight
  • Problems speaking
  • Changes in mood or behavior
  • Seizures
  • Loss of alertness

Diagnosis

The doctor will ask about your symptoms and health history. You will be asked how the injury happened. If you cannot speak, others may answer questions for you.

Images may be taken of the brain. This can be done with a CT scan.

Brain function may be tested. This can be done with neuropsychological tests.

Treatment

Treatment will depend on how severe the injury is. The goal of treatment is to give the brain time heal and to avoid lasting problems. Choices are:

Mild Injury

Mental and physical rest will be needed to give the brain time to heal. This includes limiting mental tasks like work or school. Problems may get worse when a person returns to normal activity too soon. It can also slow healing.

It will take longer to return to a sport or other physical activity. Having a second head injury before the brain has fully healed can lead to severe problems.

Moderate or Severe Injury

Emergency care will be needed. It may be:

  • Supportive care, such as oxygen, IV fluids, and nutrition therapy
  • Medicines to:
    • Ease swelling on the brain
    • Manage or stop seizures

People who are not helped by these methods may need surgery. Choices are:

  • Burr holes made through the skull to allow excess fluid to drain
  • Craniotomy to remove a section of the skull to allow room for swollen tissue

Rehabilitation

Rehabilitation may be needed to help with long term healing. Choices are:

  • Physical therapy to help with strength, flexibility, and range of motion
  • Occupational therapy to relearn tasks of daily living
  • Speech therapy
  • Mental health therapy to cope with emotions

Prevention

The risk of this problem may be lowered by:

  • Using seat belts and child safety seats when in a motor vehicle
  • Using safe, age-appropriate methods when playing sports
  • Wearing a helmet when doing activities, such as:
    • Playing a contact sport like football, soccer, or hockey
    • Riding a bike or motorcycle
    • Using skates, scooters, and skateboards
    • Catching, batting, or running bases in baseball or softball
    • Riding a horse
    • Skiing or snowboarding

Falling is a common cause in older adults. The risk may be lowered by:

  • Using handrails when walking up and down stairs
  • Having safety gates by stairs and safety guards by windows
  • Using grab bars in the bathroom
  • Placing non-slip mats in the bathroom
  • Keeping walkways clear to avoid tripping
  • Making sure rooms and hallways are well lit
RESOURCES:

American Academy of Neurology
http://www.aan.com

Brain Injury Association of America
http://www.biausa.org

CANADIAN RESOURCES:

The Brain Injury Association of Canada
http://biac-aclc.ca

Ontario Brain Injury Association
http://www.obia.on.ca

REFERENCES:

Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/concussion-and-mild-traumatic-brain-injury. Accessed February 16, 2021.

Management of Concussion/Mild Traumatic Brain Injury Working Group. Veterans Affairs/Department of Defense clinical practice guideline for management of concussion/mild traumatic brain injury. VA/DoD 2016.

Traumatic brain injury and concussion. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/traumaticbraininjury/index.html. Accessed February 16, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM  Last Updated: 2/16/2021