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Paging Dr. Frischer - Hitting your head
WRITTEN BY :   Dr. Alan Frischer

Everyone has hit his or her head – hard! Did you wonder whether or not you did serious damage? Did you lie up all night worried about concussion, or did you run off to the closest emergency room? Let’s address what to do the next time this happens to you or to a loved one.
Every year, millions of people experience a head injury. Our skulls are well designed and provide the brain with considerable protection, so most of the time these injuries are minor. More than half a million head injuries a year, however, are severe enough to require hospitalization.
A head injury is any trauma that leads to injury to the scalp, skull, or brain, and may range from a minor bump on the skull to serious brain injury. A closed head injury means there was a blow to the head but there was no break in the skull. An open or penetrating head injury means the trauma to the head caused the skull to break and an object may have entered the brain. Results of a head injury can range from a minor headache to coma and death.
Common causes include traffic accidents, falls, physical assaults and sports. When encountering a person with a possible new head injury, find out what happened. If the injured person can’t tell you, look for clues or ask witnesses. In any head injury, assume that the spinal cord has also been injured, so do not move the injured person.
Concussions occur in over four million Americans per year. A concussion is a brain injury that is caused by a sudden blow to the head or to the body. The brain is a soft organ that is surrounded by spinal fluid and protected by a hard skull. When the head or body is hit hard, the brain can suddenly crash into the skull and temporarily stop working normally.
Symptoms can last from hours to even months, and may include passing out, amnesia, confusion, slurred speech, poor concentration, feeling lightheaded, seeing stars, blurry vision, ringing in the ears, trouble standing or walking, coordination problems, nausea, and vomiting…or, there may be no symptoms at all! A doctor will diagnose a concussion by considering the presenting symptoms and listening to the story of the injury. A brain CT scan may be ordered, which will be normal if the problem is “only” concussion. The only treatment for concussion is the passage of time.
Occasionally a person with a serious concussion may, over time, develop new symptoms that are worse than the original ones. This is called post-concussive syndrome, and may include changes in the ability to think, concentrate, or remember, headaches and blurry vision, changes in sleep patterns, changes in personality, lack of interest in usual activities, changes in sex drive, dizziness, lightheadedness, or an unsteady gait. These symptoms will also eventually resolve.
Multiple concussions, as some athletes experience, can lead to permanent problems with movement, learning, or speaking. Dementia pugilistica (DP), or Punch-Drunk Syndrome, are types of dementia that affect such people. Muhammad Ali, for example, has suffered from Parkinsonian-type symptoms, and ailments such as these may not appear until years after the athletic career is over.
Skull fracture is an even more serious result of head trauma. This is when there is a break in the skull surrounding the brain and other structures. Linear skull fractures are a simple break in the bone, and follow a relatively straight line. Depressed skull fractures are common after forceful impact by blunt objects – a hammer, rock, or other heavy object. These injuries cause dents in the bone of the skull. Diagnosis is made by a CT scan or MRI of the brain.
Symptoms may include apathy, sleepiness and lethargy, difficulty speaking, swallowing, writing or reading; headaches that are often described as “the worst headache of my life;” loss of coordination or balance; tremors; nausea and vomiting; seizures; change in sensation and feeling; impaired hearing, smell, taste, or vision, drooping eyelids and differences in pupil sizes; distorted facial features; fluid draining from nose, mouth or ears; the inability to move one or more limbs; irritability; a slow breathing rate; restlessness; and a stiff neck.
Intracranial hemorrhage occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma, or from non-traumatic causes such as a hemorrhagic stroke or ruptured aneurysm. Bleeding results in increased intracranial pressure, which can crush delicate brain tissue or limit its blood supply. Severe increases in intracranial pressure can cause brain herniation, in which parts of the brain are squeezed and stop functioning properly.
Diagnosis would again be made through a CT scan or MRI. Symptoms vary depending on the location of the bleed and the amount of brain tissue affected. They usually develop suddenly, without warning, often during activity, and may be similar to those of a skull fracture, listed above.
If you should encounter a person with head injury, do not:
•Wash a head wound that is deep or bleeding a lot
•Remove any objects sticking out of a wound
•Move the person unless absolutely necessary
•Shake the person if he or she seems dazed
•Remove a helmet
• Pick up a fallen child
Consider these simple prevention tips:
•Always wear a seat belt and always buckle your child into a child safety seat, booster seat, or seat belt
•Never drive under the influence of alcohol or drugs
•Wear a helmet and make sure that your children wear helmets while riding a bicycle, motorcycle, or horse, and when skiing, snowboarding, skateboarding, or playing contact sports
•Avoid falls in the home by using a step stool with a grab bar to reach high items, installing handrails or stairways, installing window guards, using safety gates at the top and bottom of stairs, removing tripping hazards such as small area rugs or loose electrical cords, and by using non-slip mats in the bathtub or shower
• Maintain a regular exercise program to improve strength, balance, and coordination.
Even seemingly minor head traumas can become serious and sometimes life-threatening injuries. Protect yourself, and if there are any suspicious symptoms, check them out with your doctor. Be safe!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: February 24, 2011 – Volume 9 – Issue 45



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