KOCHI: Head injury is the leading cause of accidental death and disability in developing countries. Traumatic brain injury can cause permanent neurological deficit and long term sequelae severely affecting the quality of life. Head trauma can range from a minor concussion- which is a transient loss of consciousness to severe brain bleeding leading to coma or death.
The brain is a soft organ made of neural structures and has vital centres for control of breathing and circulation. Depending on the force and severity of the trauma, a head injury could be a fracture, brain tissue damage or tearing of blood vessels. The injuries may occur at the site or diagonally opposite to the site of impact.
The bleeding could be outside or inside the brain covering. Small hematomas (localised bleeding of blood vessels) are usually not life-threatening but can cause seizures, headaches, and vomiting. Severe head injury causes decreased levels of consciousness, weakness of limbs and cranial nerve dysfunction.
When the hematomas expand in size they can cause an increase in brain pressure, brain herniation and rapid deterioration of sensorium of the patient leading to breathing and circulatory disturbances. Emergency surgery is needed to evacuate the bleeding and reduce brain pressure, a delay can lead to permanent brain damage. At times, the fractured skull may compress the underlying brain which can cause seizures or infections. Such patients also need surgery to remove the fractured bone which is pressing onto the brain.
Any trauma victim with symptoms of loss of consciousness, headache, vomiting, seizure, bleeding from nose, mouth or ear and scalp wound with swelling requires clinical examination and assessment to rule out brain injury and skull fracture. A CT scan is mandatory to investigate an aberration. MRI scanning may be needed in cases where the CT is inconclusive and a diffuse axonal brain injury is suspected. Any patient suspected to have a head injury should be immediately shifted to the nearest hospital with a CT scanning facility and assessed by a neurosurgeon.
The head injury should be detected in the first golden hour after trauma. Cases of bleeding require surgery, the best results are obtained when the surgery is done at the earliest.
After head trauma, patients are usually put on anticonvulsant drugs to avoid seizures which may have to be continued for up to a year depending on the severity of the injury. Minor bleeds usually resolve in six weeks and patients can return to a normal routine. Rehabilitation is necessary for patients with serious brain trauma, this involves physiotherapy, speech therapy, and supportive care.
Avoiding rash and drunken driving will go a long way in reducing the incidence of accidents and thereby head trauma.
Wearing helmets, driving at moderate speed, wearing seat belts, abstaining from the use of cell phones while on the wheel and abiding by traffic rules are simple preventive steps each of us can follow. Better roads with proper traffic signs and strict enforcement of laws are measures required from authorities.
Dr Ajith R is a consultant neurosurgeon at SUT Hospital, Pattom. (The views expressed by the author are his own)