Types of head injury
- Concussion: a temporary disturbance of brain function, usually without anything visible on a scan
- Skull fractures, including depressed fractures where bone is pushed inwards
- Extradural and acute subdural haematomas: blood clots between the skull and brain that can press on the brain within hours
- Chronic subdural haematoma: a slow collection of old blood, often in older people or those on blood thinners, sometimes weeks after a minor bump
- Contusions and diffuse injury to the brain itself
When to go to emergency
Loss of consciousness, drowsiness or confusion, repeated vomiting, a seizure, worsening headache, weakness, clear fluid from the nose or ears, unequal pupils, or if the person is elderly or on blood thinners.
A chronic subdural haematoma can appear weeks later as headache, confusion, a new limp, or simply “not being themselves”. In an older person who has had a fall, that change is worth a CT scan.
Diagnosis
A CT scan of the head is the first test and shows bleeding and fractures within minutes. MRI is used later for injuries that CT does not explain. A neck scan is often needed too, because neck injuries travel with head injuries.
Treatment
- Observation in hospital with repeat scans for small bleeds and mild injuries
- Craniotomy to remove a clot pressing on the brain
- Burr-hole drainage for most chronic subdural haematomas, often a short procedure
- Elevation and repair of depressed skull fractures
- Decompressive craniectomy when the brain swells dangerously, with the bone replaced later
- Cranioplasty: rebuilding the skull after a craniectomy, with the patient’s own bone or a custom implant designed from their CT scan
Dr Gupta and neurotrauma
Dr Gupta is a life member of the Neurotrauma Society of India. His published work includes a study of chronic subdural haematoma in children (Child’s Nervous System, 2021), a paper on vertebral artery injury in cervical spine trauma (2022), a chapter on the history of head injury in neurosurgery, his surgical experience with fractures of the forehead and eye socket, and laboratory research on blast-related brain injury.
Recovery
Recovery depends on the injury, from a few days of rest after a concussion to months of rehabilitation after a severe injury. Headache, poor concentration, irritability and tiredness are common for weeks after even a mild head injury and usually settle. Follow-up is where problems such as a late chronic subdural haematoma are caught.
Questions
Does every head injury need a CT scan?
No. Doctors use clear rules: loss of consciousness, vomiting, confusion, a seizure, older age or blood thinners all make a scan necessary. If in doubt, get checked.
What is a chronic subdural haematoma?
A slow collection of old blood between the brain and skull, most common in older adults and people on blood thinners, sometimes appearing weeks after a minor fall. Most are treated by draining through small burr holes.
What is cranioplasty?
An operation to rebuild the skull after part of the bone was removed, often after a severe injury or swelling. The patient's own bone or a custom implant, designed from a CT scan, is fixed in place.
About Dr Gupta
This page explains the condition in general terms and is written for patients and families. It is not a diagnosis. Decisions about treatment are made in consultation, with your scans. In an emergency, go to the nearest hospital emergency department.