How Can I Tell If a Head Injury Is Mild or Severe?

Reviewed on 3/5/2021

Impact to the head can result in a number of types of head injuries, that can range in seriousness from mild to severe. Symptoms of a head injury depend on the type of injury.
Impact to the head can result in a number of types of head injuries, that can range in seriousness from mild to severe. Symptoms of a head injury depend on the type of injury.

Symptoms of a head injury depend on the type of injury. Call 911 or get to a hospital emergency department for any head injury accompanied by: 

  • Loss of consciousness
  • Confusion
  • Disorientation
  • Persistent headache
  • Differences in pupil size
  • Weak or numb extremities
  • Convulsions
  • Amnesia symptoms

These are signs a head injury may be severe. 

Symptoms of a skull fracture may include:

  • Pain, swelling, or bleeding where the injury is 
  • Swelling may take days to develop
  • Headache
  • Tiredness
  • Confusion 
  • Dizziness 
  • Fainting
  • Bruising around the eyes or behind the ear
  • Bleeding from the nose or ear
  • Clear fluid (spinal fluid) draining from the nose or ear 
  • Vomiting
  • Trouble smelling, hearing, or seeing
  • Weakness or numbness of the face

Symptoms of epidural hematoma may include:

  • Brief loss of consciousness followed by a period of awareness that lasts several hours before brain function deteriorates, sometimes leaving the patient in a coma
  • Headache
  • Vomiting
  • Seizure
  • Untreated, symptoms can include:
  • Increased blood pressure
  • Difficulty breathing
  • Brain damage 
  • Death

Symptoms of acute or chronic subdural hematoma may include:

  • Confusion
  • Dizziness
  • Nausea or vomiting
  • Loss of consciousness
  • Headache
  • Problems with balance or walking 
  • Sleepiness
  • Difficulty speaking 
  • Vision problems
  • Weakness or numbness that may come and go
  • Seizures

Symptoms of intraparenchymal hemorrhages and contusions may include:

  • Loss of consciousness
  • Cerebral edema (swelling) 

Symptoms of a concussion may include:

  • Memory problems/memory loss 
  • Confusion
  • Headache
  • Dizziness 
  • Balance problems
  • Nausea or vomiting
  • Tiredness
  • Crankiness, irritability, or not acting not like themselves
  • Problems walking or talking
  • Trouble sleeping
  • Inattention
  • Mood or behavior changes
  • Vision changes
  • Sensitivity to noise or light

What Is a Head Injury?

Impact to the head can result in a number of types of head injuries, that can range in seriousness from mild to severe. 

  • Skull fracture
    • A crack or break a bone in the skull 
    • Often causes bruising on the surface of the brain under the fracture
  • Epidural hematoma
    • A serious form of bleeding that occurs when one a blood vessel under the skull is torn during an injury and bleeds
    • Blood collects in the space between the skull and the outermost of the membranes that cover the brain (a hematoma) and can press on the brain
    • Can be life-threatening
    • Skull is usually fractured as well
  • Acute subdural hematoma
    • A blood vessel tears, and blood collects between the dura and the surface of the brain
    • Develops rapidly, often after serious head trauma caused by assault, motor vehicle accident, or fall
    • Very severe and fatal in about half of all cases
  • Chronic subdural hematoma
    • Bleeding inside the skull happens slowly
    • May occur after a relatively minor head injury in a person who is elderly, who is taking blood-thinning medications, or who has alcoholism or dementia
  • Intraparenchymal hemorrhages and contusions
    • A pooling of blood within the brain tissue
  • Concussion 
    • A traumatic brain injury caused impact to the head or body that causes the head and brain to move around quickly

What Causes a Head Injury?

Head injuries are caused by bumps, blows, jolts or impact to the head from: 

  • Motor vehicle accidents
  • Falls
  • Sports injuries or hits
  • Bicycling accidents
  • Beatings or other kinds of physical abuse

How Is a Head Injury Diagnosed?

Head injuries are diagnosed with the patient's history, neurological assessment, metal status testing, and imaging tests.

A neurologic examination includes an assessment of:

  • Cranial nerves III through VII (extraocular movements, pupillary reactivity, face sensation, and movement) 
  • Limb strength 
  • Coordination 
  • Gait

Mental status testing may include assessment of: 

Imaging tests used to diagnose a head injury include: 

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What Is the Treatment for a Head Injury?

Treatment for a head injury depends on the type of injury and the severity. 

A skull fracture may not need treatment. Treatment for a skull fracture depends on the type of fracture and where it is and may include:

  • Antibiotics to prevent infections
  • Anti-seizure medicines 
  • Vaccines to prevent certain serious or deadly infections
  • Surgery

Treatment for epidural hematoma, acute subdural hematoma, chronic subdural hematoma, and intraparenchymal hemorrhages and contusions may include:

  • Surgery 
  • Craniotomy to remove the blood clot to lower pressure on the brain and stop bleeding 
  • Burr hole drilled into the skull to allow the blood to drain 

Treatment for a small subdural hematoma may include:

  • An implanted sensor inside the head to measure intracranial pressure 
  • Medicines to control symptoms
  • Repeated CT scans to watch the hematoma 
  • Stopping blood thinners if you take them (never stop taking a prescribed medicine without first talking to your doctor)
  • Vitamin K therapy 

A mild concussion may not need treatment. Most concussions get better on their own over time. Home treatment for a mild concussion includes:

  • Rest your body and brain
    • Get plenty of sleep
    • Avoid too much physical activity 
    • Avoid activities that need concentration or a lot of attention 
  • Avoid alcohol while symptoms are still present
  • Over-the-counter (OTC) pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

How Do You Prevent Head Injury?

Head injuries may be prevented by:

  • Wearing a seatbelt when in a motor vehicle
  • Never drive under the influence of alcohol or drugs
  • Wear a helmet or appropriate headgear when on a bike, motorcycle, or playing sports 
  • Prevent falls (important for elderly adults)
    • Get rid of household hazards such as loose electrical cords, slippery rugs, and clutter
    • Wear sturdy shoes
    • Avoid walking in unfamiliar and dark areas 
    • Have eyes checked regularly and keep corrective lens prescriptions up to date
    • Do strength and balance exercises 
    • Keep the home safe for children

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Reviewed on 3/5/2021
References
https://www.uptodate.com/contents/concussion-in-adults-the-basics?search=concussion&source=search_result&selectedTitle=1~81&usage_type=default&display_rank=1

https://www.cdc.gov/headsup/basics/concussion_whatis.html

https://www.uptodate.com/contents/head-injury-in-children-and-adolescents-the-basics?search=concussion&source=search_result&selectedTitle=5~81&usage_type=default&display_rank=5

https://www.uwsp.edu/stuhealth/Documents/Other/Head%20Injury%20-%20Concussion.pdf

https://www.cdc.gov/concussion/headsup/clinicians/resource_center/complications_of_concussion.html

https://www.health.harvard.edu/a_to_z/head-injury-in-adults-a-to-z

https://www.uptodate.com/contents/skull-fractures-the-basics?search=%E2%80%A2%09Skull%20fracture&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.uclahealth.org/neurosurgery/epidural-hematomas

https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/subdural-hematoma.html

https://www.uclahealth.org/neurosurgery/cerebral-contusion-intracerebral-hematoma

https://www.cdc.gov/traumaticbraininjury/prevention.html