5th August 2024

Head injury

Head injuries are an extremely common A&E presentation, especially in teenagers, young adults and the elderly. Possible consequences of head injury include concussion, intracerebral haemorrhage, contusion, axonal injuries and skull fracture. Patients presenting with head injuries should be assessed using the ATLS (advanced trauma life support) guidelines. CT brain will identify most injuries. The guidelines as to when a CT head is indicated is shown in the table below.

Concussion is the most common injury seen in head trauma, however these microscopic changes cannot be seen on CT. The diagnosis is therefore clinical and symptoms include headache, dizziness and confusion.

Subdural haematomas usually occur in motor-vehicle accidents or falls. They are more common in those with cerebral atrophy or coagulopathies. Patients may develop confusion or focal neurological deficits (Figure 8).

Extradural haematomas usually occur after direct force to the skull and can be associated with fractures of the temporal bone. Patients may experience a lucid interval before a subsequent deterioration in GCS (Figure 9).

Image Source: Wikimedia Commons (2012). Subduralandherniation, Licensed under a creative commons licence. Available for free at: https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG (Accessed: 16 January 2024)

Image Source: Wikimedia Commons (2012). Traumatic acute epidual hematoma, Licensed under a creative commons licence. Available for free at: https://en.wikipedia.org/wiki/Epidural_hematoma#/media/File:Traumatic_acute_epidual_hematoma.jpg (Accessed: 16 January 2024)