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Jeffrey Bazarian, MD, BrainLine
People like Natasha Richardson and others who've just had their brains jostled may be in no condition to decide if they need medical care. And the people around them may not know that hitting your head can be dangerous even if you don't lose consciousness. How do you know when you should go to the hospital after having "your bell rung"?
Going to the hospital after a head injury can mean the difference between life and death. But how do you know when to go? This can seem like a difficult decision, but let me sum up the answer for you: when in doubt, go to the hospital. Not later. Not tomorrow. Now!
Here's why.
The hospital is the only place that has a CAT scanner that can "look" inside your head and determine if there is any bleeding in your brain. Bleeding in the brain can be life-threatening when there is enough blood in the right spot to press down on the brain and squeeze it. These dangerous forms of bleeding are called epidural and subdural hematomas. Because the brain is trapped inside the skull, slow bleeding can force important parts of the brain against the inside of the skull and through the small hole in the base of the skull called the foramen magnum. These important brain areas, which control breathing and heart rate, stop working when they get squeezed and this is what results in death. With a CAT scan, epidural and subdural hematomas are easily diagnosed. The treatment requires surgery to remove the blood clot. The quicker the surgery, the better the chances for a good outcome.
So, how do you know when to go to the hospital? The decision is easy if you're the one making it for someone else and that person is not responding to you or looks asleep. This is called coma. The risk of a subdural or epidural hematoma in comatose head injured patients is high and you should summon an ambulance immediately!
But what if the head injury doesn't cause a coma? What if the head injury just causes a brief loss of consciousness, brief period of amnesia, or a sensation of feeling dazed? A person who has such an injury — termed concussion or mild traumatic brain injury — can look, and even feel, just fine. The problem is, even though the person looks good on the outside, inside the skull there is a small chance that slow bleeding is taking place. After a concussion, the chances of this happening are not large — about 1 in 1000 — but the only way to diagnose it is with that hospital-based CAT scan.
Here are the symptoms of a concussion that should prompt an immediate trip to the hospital or emergency department.
- Loss of consciousness, even if only briefly
- Any period of amnesia, or loss of memory for the event
- Feeling dazed or confused
- Headache
- Vomiting
- Seizure
- In addition, for children under 2 years of age, any scalp swelling or abnormality in the way they usually behave.
One word of caution: because any brain injury — even a concussion — has the potential to injure the brain, the brain-injured patient may lack the judgment to make an informed decision regarding whether or not to go to the hospital. Family and friends can be instrumental in helping the patient chose a course of action that is best for him or her. And when in doubt, go to the hospital!
Jeffrey Bazarian, MD,
Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.
He graduated from Brown University and from the University of Rochester School of Medicine. He completed his residency training in Internal Medicine and has a Masters of Public Health. Dr. Bazarian was one of the first emergency physicians to be awarded a five-year Career Development Award from the National Institute of Neurologic Disorders and Stroke. The focus of his research was traumatic brain injury epidemiology and outcomes.
Over the years, Dr. Bazarian's research interest shifted to finding better ways to diagnose traumatic brain injury, especially concussion. He assembled a diverse group of researchers within the University to tackle this problem, creating a truly translational research team. These efforts earned him an R01 award in 2007 from the National Institutes of Child Health and Human Development to develop a blood test for brain injury, making him one of only a handful of emergency physicians nationally to have such a grant.
Dr. Bazarian has served on several TBI-related task forces and panels for the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Science Foundation. He is currently involved in an Institute of Medicine panel attempting to determine the long-term health consequence of head injuries among American troops serving in Iraq and Afghanistan.
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Thank you for your helpful information on head injuries, my mother fell hitting her head full on the concrete floor. We were not so sure if she should go to the hospital or not, looking it up on the web we found this website, which answered all of our questions right away! We now all know that the best thing to do is get information from some one who works at a hospital, so my mom called a nurse for her opinion; the nurse told my mom that it is not as bad as she thinks. -thanks again!
Mar 12th, 2011 1:39pm