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Closed Head Injury

Closed head injury is any traumatic brain injury to the head that does not penetrate the skull. It is usually caused by a blow to the head, and frequently occurs in traffic accidents, falls and assaults. Closed head injury is also common in children who have suffered serious bicycle accidents.

There are a variety of risks associated with closed head injury. If the strike is powerful enough, the victim may suffer from intracranial pressure or brain swelling, which can permanently destroy delicate brain tissue and nerve cells, in turn leading to permanent brain damage.

Types of Closed Head Injury

The degree of brain damage depends on the severity of the closed head injury. Many victims suffer mild injuries, while others experience fatal effects. There are several different types of closed brain injury, including concussion, brain contusion, diffuse axonal injury and hematoma.

Concussion

Although definitions vary, the Mayo Clinic defines concussion as any head injury that temporarily affects normal brain functions. Most concussions are mild and do not cause loss of consciousness, but this is not always the case. Sports are a common cause of concussions in the United States. Almost half of the 600,000 total concussion cases reported each year are sports-related.

People suffering from a concussion can exhibit a number of immediate symptoms, including:

Concussion victims also may be confused, unable to concentrate or have difficulty balancing. In other cases, symptoms do not surface until hours or days after the incident. These secondary symptoms include mood swings, sensitivity to light and noise, and changes in sleep patterns.

Brain Contusion

Brain contusions are bruises of the brain tissue that occur after brain trauma and cause hemorrhages to appear and be absorbed into the brain tissue. In some instances, blood may be absorbed into the cerebrospinal fluid and cause permanent neurological damage. Brain contusions are localized, a characteristic that distinguishes them from concussions, which are more diffuse (spread out).

Brain contusions are present in 20 to 30 percent of all severe head injuries. People suffering from brain contusions may feel weak and numb, lose their coordination and struggle with memory or cognitive problems. Because brain contusions and other head injuries can increase intracranial pressure, it is important to seek immediate medical care after any head injury.

Diffuse Axonal Injury

One of the most debilitating traumatic brain injuries is diffuse axonal injury. Frequently caused by high-speed transportation accidents — and sometimes associated with shaken baby syndrome — diffuse axonal injury causes permanent damage to nerves in the brain. As with other closed head injuries, those suffering from this injury may experience intracranial pressure and brain swelling. But unlike victims with more minor closed head injuries, 90 percent of patients with severe diffuse axonal injuries end up in vegetative states or comas.

Intracranial Hematoma

Intracranial hematoma occurs when the brain is forced against the inside of the skull, resulting in a pool of blood outside the blood vessels of the brain or in between the skull and brain. The brain is not designed to drain this much fluid. As a result, intracranial hematoma can compress brain tissue, requiring immediate medical attention. Blood that collects in the brain, or in between the brain and skull, may cause patients to fall unconscious or experience seizures and/or lethargy.

There are three types of intracranial hematomas: subdural, epidural and intraparenchymal. Subdural hematoma is a ruptured vein between the brain and the dura mater, the membranes surrounding the brain. Epidural hematoma is a rupture between the dura mater and the skull, while intraparenchymal hematoma occurs when blood collects within the brain tissue. Intracranial hematoma is a serious condition that often requires surgery and extensive recovery time.

Closed Head Injury Complications

All traumatic brain injuries put patients at risk of developing a variety of complications, including intracranial pressure and swelling of the brain. Patients with damaging closed head injuries may suffer from:

Most mild closed head injury patients report headaches, dizziness and short-term memory loss. In severe closed head injury cases, vegetative states or death may occur.

Closed Head Injury Treatment

Traumatic brain injury treatment depends on the severity of the injury. For patients with mild injuries, doctors recommend rest and over-the-counter pain relievers. Patients with serious closed head injuries require more medical attention.

Doctors treating severe closed head injuries seek to prevent further brain damage by easing intracranial pressure. This can usually be achieved with diuretics, anti-seizure medication or coma-inducing drugs. Patients with intracranial hematoma usually require surgery to drain clotted blood deposits. Surgeons also may open a "window in the skull" to accommodate brain swelling until it subsides.

Closed Head Injury Rehabilitation

Following surgery and medication, many patients with severe closed head injuries need therapy to regain basic motor and cognitive skills. Depending on what part of the brain was damaged, patients may struggle with walking, speaking or loss of memory.

Victims typically begin their therapy during their time in the hospital and continue it on an out-patient basis. A skilled team of neuropsychologists, physical therapists and others work closely with patients to help them manage or regain their lost skills. The amount of traumatic brain injury rehabilitation required varies depending on the individual.

Closed head injury is a serious type of traumatic brain injury. Continue reading more articles on this site to learn about causes, treatments, and other types of traumatic brain injury, such as open head injury.

[Last revision: April 2009]

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