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Closed Head Injury

A closed head injury is any injury to the head that does not penetrate the skull. Closed head injuries are usually caused by blows to the head and frequently occur 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. Strong blows to the head can lead to complications such as brain swelling and intracranial pressure, which can permanently destroy delicate brain tissue and nerve cells, in turn leading to permanent brain damage.

Types of Closed Head Injury

The extent of a patient's brain damage depends on the severity of the injury. Closed head injuries range from mild skull injuries to traumatic brain injuries, which can lead to severe brain damage or even death. There are several different types of closed head injury, including concussion, brain contusion, diffuse axonal injury and hematoma.


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:

  • Headache
  • Dizziness
  • Nausea
  • Ringing in the ears
  • Slurred speech
  • Vomiting

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 as a result of brain trauma. In some cases, brain contusions lead to hemorrhages which are absorbed into the brain tissue. If blood is absorbed into the cerebrospinal fluid it can 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 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, diffuse axonal injury may cause brain swelling and intracranial pressure. But unlike more minor closed head injuries, severe diffuse axonal injuries lead to vegetative states or comas in 90 percent of patients.

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 lead to unconsciousness, seizures and/or lethargy.

There are three types of intracranial hematoma: subdural, epidural and intraparenchymal. Subdural hematoma occurs when a vein ruptures between the brain and the dura mater (the membranes surrounding the brain); epidural hematoma is caused by a rupture between the dura mater and the skull; and 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

A traumatic brain injury can put a patient at risk of developing a variety of complications, including intracranial pressure and swelling of the brain. Patients with serious closed head injuries may suffer from:

  • Seizures
  • Nerve damage
  • Cognitive disabilities
  • Communication difficulties
  • Personality changes
  • Changes in sensory perception
  • Post-concussion syndrome
  • Coma

Most patients suffering from mild closed head injury report headaches, dizziness and short-term memory loss. A severe closed head injury can lead to death or cause a patient to remain in a permanent vegetative state.

Closed Head Injury Treatment

Traumatic brain injury treatment, such as for closed head injury, 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 additional 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.

Closed head injury patients typically begin their therapy during their time in the hospital and continue it on an outpatient 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: August 2009]

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