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When to See a Doctor by Charles Watson


Posted on April 5, 2020

Head injuries can range from a bump on the head to a skull fracture caused either by a blow to the head, or a penetrating injury that damages the brain. A TBI damages the brain causing a bruise, internal bleeding or a blood clot, also known as an intracranial hematoma. TBIs may range from mild to severe, and the symptoms of a head injury may occur immediately following the trauma, or they may slowly develop over several hours or days. 

Concussions are usually classified as mild TBI usually caused by repeated blows to the head, and a common sports injury. Symptoms include confusion, memory and/or concentration problems, dizziness, headaches, loss of consciousness for a few seconds or a few minutes, nausea and vomiting, memory loss of events before the injury or immediately after it and altered levels of consciousness as being drowsy or difficulty to remain awake. 

A contusion is a bruise to the brain often characterized by swelling (edema) and an increase in pressure (ICP) within the skull, causing dilated pupils, high B.P, low pulse rate and abnormal breathing. 

How do doctors diagnose a mild brain injury?

A patient with a mild brain injury can often present as mentally confused. A doctor will inquire about the person’s medical history and how the injury took place along with a careful examination of the head, face and neck.   

A doctor may ask questions to check a person’s memory, concentration or problem-solving abilities. They may also use the Glasgow Coma Scale (GCS) which is a scale from 3 to 15 that identifies how serious the injury to the brain is.

Doctors base their rating after examining the person’s

  • Ability to open their eyes
  • Ability to communicate 
  • A motor response such as bending an arm at the elbow.

A GCS score of 13 or above indicates a mild injury, a score of 9 to 12 would indicate a moderate one and a score of less than 8 means a severe head injury.

Severe brain injuries that may require immediate attention

A skull fracture is a crack or breaks in the skull, with or without a laceration to the skin. Symptoms include tenderness, swelling, skull deformity, bruising around eyes or behind the ear, clear fluid leaking from the nose or ear. 

Bleeding in the brain, hemorrhage is a potentially life-threatening condition which requires immediate medical attention by a neurosurgeon. When a blood vessel in the brain bursts, causing bleeding into the surrounding tissues, swelling and increased ICP. Blood clots called epidural, or subdural hematomas (depending on the site in the brain) may develop.  

These injuries are usually severe, and symptoms include seizures, nausea or repeated vomiting, sudden severe headaches, lethargy, loss of consciousness and weakness in arm or leg. 

In infants and toddlers who cannot properly express, signs of a head injury include vomiting, seizures, scalp lacerations or swelling and abnormal behavior.

Severe injury to the brain requires a doctor’s intervention who may perform a physical and neurologic exam that includes an EEG, CT scan and an MRI to assess the nature and severity of the injury and determine an appropriate course of treatment. 

Persons who suffer from a severe brain injury may lose muscle strength, fine motor skills, speech, vision, hearing, long term or short term changes in personality or behavior. Such people may require long term medical and rehabilitative management.  

The extent of recovery will depend on the type of brain injury and other medical issues that may be present. Positive reinforcement will encourage patients to strengthen their self-esteem and promote independence.