Categories: Neurology

Emergency management of Traumatic Head Injury

Traumatic brain injury (TBI) is a sudden injury to the scalp, skull, and brain. It happens when a bump, blow, jolt, or other injury damages the brain due to a strong or violent strike to head. It can also occur when an object, like a bullet or piece of skull, pierces the brain tissue. TBI can be mild, moderate or severe, it depends on the damage. Older people are more vulnerable to this condition because of older people the highest rates of TBI related hospitalization and death.


A head injury can be of any type, it can be closed, i.e. no cut or laceration of the skin, or it can penetrate where skin and/or bone of the skull is broken. A symptom of the head injury may be visible immediately after a trauma or may develop slowly after several hours or days.

  1. Concussion:

It is also known as traumatic brain injury. This type of injury occurs when blowing to the head or body, a fall, other trauma that shakes the brain inside the skull. Few symptoms are as follows:

  • For a few minutes or seconds of loss of consciousness
  • Confusion state, memory loss, or concentration problems
  • Headache
  • Dizziness
  • Neck pain
  • Ringing in ears
  • Slow reflexes
  • Amnesia (memory loss) of events before the injury or immediately after it
  • Vomiting and nausea
  • Low level/brief loss of consciousness, drowsiness, or difficulty to keep awaken
  1. Contusion:

The damage of the brain tissue creates swelling and increase the pressure on the skull. This pressure is called Intracranial Pressure (ICP). A symptom of ICP within the skull and brain are as follows:

  • Blurry vision
  • Dilated (larger than normal) pupil
  • High blood pressure
  • Low pulse rate
  • Slurred speech
  • Lasting headache
  • Weakness or numbness in arms and legs
  • Trouble waking up, walking or speaking
  • Nausea or vomiting
  • Abnormal breathing
  1. Fracture:

Crack or break in the skull, with or without laceration to the skin. The symptoms of skull fractures are as follows:

  • Tenderness
  • Swelling
  • Skull deformity
  • Bruising around the eyes or behind the ear
  • Clear fluid leaking from the nose or ear
  1. Bleeding:

Bleeding of the brain is known as haemorrhage. Haemorrhage is a life-threatening stage. Urgent attention to a neurosurgeon is required now. Brain haemorrhage occurs when a brain’s blood vessels get burst. That causes bleeding from that part of the vessel and the surrounding tissues of the brain lead to swelling and intracranial pressure. Blood may collect and clot. It is known as a hematoma. Bleeding in the brain symptoms may suddenly appear and gradually get worse. Few of them are:

  • Severe headache
  • Seizures
  • Nausea or vomiting
  • Lethargy
  • Weakness in an arm or leg
  • Loss of consciousness.
  1. Diffuse Axonal Injury (Shear Injury):

This type of injury occurs when the brain bounces violently inside the skull. In this nerve cells of nerve fibres get stretched or torn that make permanent damage to brain cells and cause other complications of the nervous system. The main symptom of Diffuse Axonal Injury is a prolonged loss of consciousness.

  1. Infant’s Injury:

Few signs for toddlers and infants injury are as follows:

  • If a child is not behaving or acting normally
  • Vomiting or nausea
  • Scalp lacerations and swelling
  • Seizures


Immediate medical attention for any head injury is always recommended. Unrecognized/inappropriately treated head injury may be potentially serious. Serious or traumatic brain injuries, often requires emergency care, such as surgery to remove blood clots and relieve the pressure of the brain. Minor head injuries will be treated and observed by its symptoms that may include pain medication of headache and medications for nausea and vomiting. If a patient has a symptom of concussion, then he/she should avoid being overactive. The doctor will suggest some precautions for returning to normal life and sports activity.


A neurological examination and queries related to injury and symptoms will help the doctor to know about the severity of brain injury. Other tests are X-ray, Computerized Tomography (CT) Scan, or Magnetic Resonance Imaging (MRI).

Dr. Manaranjan Jena, Consultant Neuro Surgeon, Narayana Multispeciality Hospital, Barasat

Narayana Health

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