Head and Brain Injuries

Around the world each year, over 1 million people die and 1 million more are disabled from head and brain injuries. Despite their status as a global epidemic, head and brain injuries are also considered a silent epidemic. Serious head and brain injury can occur even without a loss of consciousness and can be overlooked following traffic accidents and sports injuries. A lack of understanding about the nature of head and brain injury among the general public, as well as lack of affordable, accessible medical care, prevents people from seeking treatment after sustaining such trauma. Head injury is a trauma to the head that may or may not involve the brain. Head injuries are classified as internal or external and are further categorized by mechanism, morphology, and severity. Practical prevention and education about head and brain injuries among the general public, as well as effective diagnosis, treatment, and rehabilitation services for affected individuals are of global health importance.

Head injury is a trauma to the head that may or may not involve the brain. Brain injury is often used synonymously with head injury though the latter may not actually involve any neurological complications. Head injuries may be internal or external and can be categorized by mechanism (closed injury or penetrating injury), morphology (fractures, focal intracranial injury, or diffuse intracranial injury), and severity (mild, moderate, or severe). An external head injury is one that does not affect the skull or brain. External injuries may involve a laceration which causes profuse bleeding due to the thousands of blood vessels in the scalp, or trauma which may cause swelling due to fluid or blood buildup beneath the scalp. These injuries can take days or weeks to heal.

Internal head injuries are further classified as closed head injury or penetrating head injury. Closed head injuries include any injury in which the scalp is not broken open. Closed head injury may occur with or without damage to the bones of the skull. For example, if a car stops suddenly and passengers experience whiplash, the brain may be jarred and result in concussion although the skull remains intact. Alternately, if the bones of the skull are smashed into the brain as a result of blunt trauma, but the scalp is not lacerated, this too is categorized as a closed head injury. Penetrating head injury occurs when an object transects the scalp, skull, and brain. A bullet that passes into the brain is an example of a penetrating head injury; wounds of this type can cause skull fragments to pierce the brain tissue and are susceptible to infection.

Skull fractures are the result of any head injury that breaks the bones of the cranium. All skull fractures are internal injuries though they may not be outwardly visible. Symptoms of skull fractures can include: blood or clear fluid leaking from the nose or ear, unequal pupil size, discoloration around the eyes or ears, swelling or indentation of the cranium, loss of consciousness, memory lapse, blurred vision, confusion, [Page 777]irritability, or headache. Skull fractures are categorized as linear, depressed, diastatic, or basilar. Linear fractures are a simple break in the bone that does not require serious medical intervention. Depressed fractures are a dented deformation of the skull that often requires surgical intervention. Diastatic fractures occur along the natural suture lines of the cranial bones causing the space between them to widen. This type of injury is more common among infants prior to fusion of these bones. Basilar fractures occur at the base of the skull and may affect the cribiform plate, occipital, temporal, frontal, and sphenoid bones. This type of injury is rare and requires more force than a cranial vault fracture. However, basilar fractures are generally considered severe as they are more likely to be associated with spinal cord, blood vessel, and nerve damage and are susceptible to meningeal infection.

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