Head injury

A number of sports such as boxing, horse-riding, and cycling, carry a high risk of head injury. A blow to the head can result in brain damage and should be treated with great caution. Other injuries, such as those to the face, may be potentially disfiguring or disabling. If a head injury causes numbness, an inability to move the limbs, or a pins-and-needles sensation, it should be treated very seriously and medical advice sought. See also concussion.

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Definition

Head injury is an injury to the scalp, skull, or brain. The most important consequence of head trauma is traumatic brain injury. Head injury may occur either as a closed head injury, such as the head hitting a car's windshield; or as a penetrating head injury, as when a bullet pierces the skull. Both may cause damage that ranges from mild to profound. Very severe injury can be fatal because of profound brain damage.

Description

External trauma to the head is capable of damaging the brain, even if there is no external evidence of damage. More serious injuries can cause skull fracture, blood clots between the skull and the brain, or bruising and tearing of the brain tissue itself.

Injuries to the head can be caused by traffic accidents, sports injuries, falls, workplace accidents, assaults, or bullets. Most people have had some type of head injury at least once in their lives, but rarely do they require a hospital visit.

Demographics

Each year about two million people suffer from a more serious head injury, and up to 750,000 of those are severe enough to require hospitalization. Brain injury is most likely to occur in males between ages 15 and 24, usually as a result of car and motorcycle accidents. About 70 percent of all accidental deaths are due to head injuries, as are most of the disabilities that occur after trauma. Among children and infants, head injury is the most common cause of death and disability. The most common cause of head injury in children under age two is child abuse.

Causes and Symptoms

A head injury may cause damage both from the direct physical injury to the brain and from secondary factors, such as lack of oxygen, brain swelling, and disturbance of blood flow. Both closed and penetrating head injuries can cause swirling movements throughout the brain, tearing nerve fibers and causing widespread bleeding or a blood clot in or around the brain. Swelling may raise pressure within the skull (intracranial pressure) and may block the flow of oxygen to the brain.

Head trauma may cause a concussion, in which there is a brief loss of consciousness without visible structural damage to the brain. In addition to loss of consciousness, initial symptoms of brain injury may include:

• memory loss and confusion
• vomiting
• dizziness
• partial paralysis or numbness
• shock
• anxiety

After a head injury, there may be a period of impaired consciousness followed by a period of confusion and impaired memory with disorientation and a breakdown in the ability to store and retrieve new information. Others experience temporary amnesia following head injury that begins with memory loss over a period of weeks, months, or years before the injury (retrograde amnesia). As a person recovers, memory slowly returns. Post-traumatic amnesia refers to loss of memory for events during and after the accident.

Epilepsy occurs in 2–5 percent of those who have had a head injury; it is much more common in people who have had severe or penetrating injuries. Most cases of epilepsy appear right after the accident or within the first year and become less likely with increased time following the accident.

Closed Head Injury

Closed head injury refers to brain injury without any penetrating injury to the brain. It may be the result of a direct blow to the head; of the moving head being rapidly stopped, such as when a person's head hits a windshield in a car accident; or by the sudden deceleration of the head without its striking another object. The kind of injury the brain receives in a closed head injury is determined by whether the head was unrestrained upon impact and the direction, force, and velocity of the blow. If the head is resting on impact, the maximum damage will be found at the impact site. A moving head will cause a contrecoup injury where the brain damage occurs on the side opposite the point of impact, as a result of the brain slamming into that side of the skull. A closed head injury also may occur without the head being struck, such as when a person experiences whiplash. This type of injury occurs because the brain is of a different density than the skull and can be injured when delicate brain tissues hit against the rough, jagged inner surface of the skull.

Penetrating Head Injury

If the skull is fractured, bone fragments may be driven into the brain. Any object that penetrates the skull may implant foreign material and dirt into the brain, leading to an infection.

Skull Fracture

A skull fracture is a medical emergency that must be treated promptly to prevent possible brain damage. Such an injury may be obvious if blood or bone fragments are visible, but it is possible for a fracture to have occurred without any apparent damage. A skull fracture should be suspected if there is:

• blood or clear fluid leaking from the nose or ears
• unequal pupil size
• bruises or discoloration around the eyes or behind the ears
• swelling or depression of part of the head

Intracranial Hemorrhage

Bleeding (hemorrhage) inside the skull may accompany a head injury and cause additional damage to the brain. A blood clot (hematoma) may occur if a blood vessel between the skull and the brain ruptures; when the blood leaks out and forms a clot, it can press against brain tissue, causing symptoms from a few hours to a few weeks after the injury. If the clot is located between the bones of the skull and the covering of the brain (dura), it is called an epidural hematoma. If the clot is between the dura and the brain tissue itself, the condition is called a subdural hematoma. In other cases, bleeding may occur deeper inside the brain. This condition is called intracerebral hemorrhage or intracerebral contusion (from the word for bruising).

In any case, if the blood flow is not stopped, it can lead to unconsciousness and death. The symptoms of bleeding within the skull include:

• nausea and vomiting
• headache
• loss of consciousness
• unequal pupil size
• lethargy

Postconcussion Syndrome

If the head injury is mild, there may be no symptoms other than a slight headache. There also may be confusion, dizziness, and blurred vision. While the head injury may seem to have been quite mild, in many cases symptoms persist for days or weeks. Up to 60 percent of persons who sustain a mild brain injury continue to experience a range of symptoms called postconcussion syndrome as long as six months or a year after the injury.

The symptoms of postconcussion syndrome can result in a puzzling interplay of behavioral, cognitive, and emotional complaints that can be difficult to diagnose, including the following:

• headache
• dizziness
• mental confusion
• behavior changes
• memory loss
• cognitive deficits
• depression
• emotional outbursts

When to Call the Doctor

A parent of a child who has had a head injury and who is experiencing any the following symptoms should seek medical care immediately:

• serious bleeding from the head or face
• loss of consciousness, however brief
• confusion and lethargy
• lack of pulse or breathing
• clear fluid drainage from the nose or ear

Diagnosis

The extent of damage in a severe head injury can be assessed with computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, electroencephalograms (EEG), and routine neurological and neuropsychological evaluations.

Doctors use the Glasgow Coma Scale to evaluate the extent of brain damage based on observing a person's ability to open his or her eyes, respond verbally, and respond to stimulation by moving (motor response). People can score from three to 15 points on this scale. People who score below eight when they are admitted usually have suffered a severe brain injury and will need rehabilitative therapy as they recover. In general, higher scores on the Glasgow Coma Scale indicate less severe brain injury and a better prognosis for recovery.

Individuals with a mild head injury who experience symptoms are advised to seek out the care of a specialist; unless a family physician is thoroughly familiar with medical literature in this area, experts warn that there is a good chance that people's complaints after a mild head injury will be downplayed or dismissed. In the case of mild head injury or postconcussion syndrome, CT and MRI scans, electroencephalograms (EEG), and routine neurological evaluations all may be normal because the damage is so subtle. In many cases, these tests cannot detect the microscopic damage that occurs when fibers are stretched in a mild, diffuse injury. In this type of injury, the axons lose some of their covering and become less efficient. This mild injury to the white matter reduces the quality of communication between different parts or the brain. A PET scan, which evaluates cerebral blood flow and brain metabolism, may be of help in diagnosing mild head injury.

Persons with continuing symptoms after a mild head injury should call a local chapter of a head-injury foundation that can refer people to the best nearby expert.

Treatment

If a concussion, bleeding inside the skull, or skull fracture is suspected, the person should be kept quiet in a darkened room, with head and shoulders raised slightly on pillow or blanket.

After initial emergency treatment, a team of specialists may be needed to evaluate and treat the problems that result. A penetrating wound may require surgery. Those with severe injuries or with a deteriorating level of consciousness may be kept hospitalized for observation. If there is bleeding inside the skull, the blood may need to be surgically drained; if a clot has formed, it may need to be removed. Severe skull fractures also require surgery. Supportive care and specific treatments may be required if the person experiences further complications. People who experience seizures, for example, may be given anticonvulsant drugs, and people who develop fluid on the brain (hydrocephalus) may have a shunt inserted to drain the fluid.

In the event of long-term disability as a result of head injury, there are a variety of treatment programs available, including long-term rehabilitation, coma treatment centers, transitional living programs, behavior management programs, life-long residential or day treatment programs and independent living programs.

Prognosis

Prompt, proper diagnosis and treatment can help alleviate some of the problems that may develop after a head injury. However, it usually is difficult to predict the outcome of a brain injury in the first few hours or days; a person's prognosis may not be known for many months or even years.

The outlook for someone with a minor head injury generally is good, although recovery may be delayed, and symptoms such as headache, dizziness, and cognitive problems can persist for up to a year or longer after an accident. This can limit a person's ability to work and cause strain in personal relationships.

Serious head injuries can be devastating, producing permanent mental and physical disability. Epileptic seizures may occur after a severe head injury, especially a penetrating brain injury, a severe skull fracture, or a serious brain hemorrhage. Recovery from a severe head injury can be very slow, and it may take five years or longer to heal completely. Risk factors associated with an increased likelihood of memory problems or seizures after head injury include age, length and depth of coma, duration of post-traumatic and retrograde amnesia, presence of focal brain injuries, and initial Glasgow Coma Scale score.

As researchers learn more about the long-term effects of head injuries, they uncover links to later conditions. A 2003 report found that mild brain injury during childhood could speed up expression of schizophrenia in those who were already likely to get the disorder because of genetics. Those with a history of a childhood brain injury, even a minor one, were more likely to get familial schizophrenia than a sibling and to have earlier onset. Another study in 2003 found that people who had a history of a severe head injury were four times more likely to develop Parkinson's disease than the average population. Those requiring hospitalization for their head injuries were 11 times as likely. The risk did not increase for people receiving mild head injuries.

Prevention

Many severe head injuries could be prevented by wearing protective helmets during certain sports and when riding a bike or motorcycle. Seat belts and airbags can prevent many head injuries that result from car accidents. Appropriate protective headgear always should be worn on the job where head injuries are a possibility.

Parental Concerns

Parents should insist that their children always use a seat belt when riding in a car. They should also insist that appropriate protective headgear always be worn when children engage in activities such as bicycling or rollerblading during which a head injury is possible. If a parent suspects a caregiver of abusing their child, prompt intervention is required.

Resources

Books

Hergenroeder, Albert C., and Joseph N. Chorley. "Head and Neck Injuries." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 2313–4.

Hodge, Charles J. "Head Injury." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 2241–2.

Ropper, Allan H. "Traumatic Injuries of the Head and Spine." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 2434–41.

Saunders, Charles E., et al. Current Emergency Diagnosis and Treatment. New York: McGraw-Hill, 2003.

Periodicals

Chamelian, L., and A. Feinstein. "Outcome after mild to moderate traumatic brain injury: The role of dizziness." Archives of Physical Medicine and Rehabilitation 85, no. 10 (2004): 1662–6.

Hrysomallis, C. "Impact energy attenuation of protective football headgear against a yielding surface." Journal of Science and Medicine in Sport 7, no. 2 (2004): 156–64.

Stern, B., et al. "Profiles of patients with a history of mild head injury." International Journal of Neuroscience 114, no. 9 (2004): 1223–37.

Stocchetti, N., et al. "Inaccurate early assessment of neurological severity in head injury." Journal of Neurotrauma 21, no. 9 (2004): 1131–40.

Organizations

American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee, WI 53202. Web site: www.aaem.org/.

American Academy of Neurology. 1080 Montreal Avenue, St. Paul, MN 55116. Web site: www.aan.com/

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: www.aap.org/.

American College of Emergency Physicians. PO Box 619911, Dallas, TX 75261–9911. Web site: www.acep.org/.

American College of Sports Medicine. 401 W. Michigan St., Indianapolis, IN 46202–3233. Web site: www.acsm.org/.

International Brain Injury Association. 1150 South Washington St., Suite 210, Alexandria, VA 22314. Web site: www.internationalbrain.org/.

Web Sites

Cyr, Dawna L., and Steven B. Johnson. "First Aid for Head Injuries." University of Maine Cooperative Extension. Available online at www.cdc.gov/nasd/docs/d000801-d000900/d000815/d000815.html (accessed January 6, 2005).

"Head and Brain Injuries." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/headandbraininjuries.html (accessed January 6, 2005).

"Head Injuries: What to Watch for Afterward." American Academy of Family Physicians. Available online at (accessed January 6, 2005).

"Head Injury." Institute for Neurology and Neurosurgery. Available online at (accessed January 6, 2005).

"The Management of Minor Closed Head Injury in Children (AC9858)." American Academy of Pediatrics. Available online at www.aap.org/policy/ac9858.html (accessed January 6, 2005).

[Article by: L. Fleming Fallon, Jr., MD, DrPH]

Damage caused by physical trauma to the head. Acute head injuries are classified as concussion fractures, contusions, and haemorrhage (or haematoma). They are usually caused by a direct blow and can be serious because they involve the brain, spinal cord, and surrounding nerves and sense organs, or they may disfigure or disable delicate structures in the face. A blow to the skull is almost inevitable in contact and collision sports. Most athletes who sustain such a blow recover quickly and have no long-lasting ill-effects. Nevertheless, even a seemingly innocuous blow can have dire consequences (e.g. see epidural haematoma). Therefore, every head injury should be dealt with cautiously and any loss of consciousness should be medically investigated.

Head injury
Classification and external resources
ICD-10	S00.0S09
ICD-9	800-879
eMedicine	neuro/153
MeSH	D006259

See also: Traumatic brain injury

Head injury refers to trauma of the head. This may or may not include injury to the brain.^[1] However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature.^[2]

The incidence (number of new cases) of head injury is 300 of every 100,000 per year (0.3% of the population), with a mortality rate of 25 per 100,000 in North America and 9 per 100,000 in Britain. Head trauma is a common cause of childhood hospitalization.^{[citation needed]}

Contents 1 Classification 1.1 Concussion 1.2 Intracranial hemorrhage 1.2.1 Intra-axial hemorrhage 1.2.2 Extra-axial hemorrhage 1.3 Cerebral contusion 1.4 Diffuse axonal injury 2 Signs and symptoms 3 Causes 4 Diagnosis 5 Management 6 Prognosis 7 References 8 External links

Classification

Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull.

Head injuries may be closed or open. A closed (non-missile) head injury is where the dura mater remains intact. The skull can be fractured, but not necessarily. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area.

A head injury may cause a minor headache skull fracture, which may or may not be associated with injury to the brain. Some patients may have linear or depressed skull fractures.

If intracranial hemorrhage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy surgeries are used in these cases to lessen the pressure by draining off blood.

Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to a contrecoup effect (the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact).

If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull (both are contrecoup injuries).

Private Patrick Hughes, Co. K, 4th New York Volunteers, wounded at the battle of Antietam on September 17, 1862.

Specific problems after head injury can include^{[citation needed]}:

• Skull fracture
• Lacerations to the scalp and resulting hemorrhage of the skin
• Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly
• Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull
• Traumatic subarachnoid hemorrhage
• Cerebral contusion, a bruise of the brain
• Concussion, a loss of function due to trauma
• Dementia pugilistica, or "punch-drunk syndrome", caused by repetitive head injuries, for example in boxing or other contact sports
• A severe injury may lead to a coma or death
• Shaken Baby Syndrome - a form of child abuse

Concussion

Main article: Concussion

Mild concussions are associated with sequelae. Severity is measured using various concussion grading systems.

A slightly greater injury is associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In all cases the patients develop postconcussion syndrome, which includes memory problems, dizziness, tiredness, sickness and depression.

Cerebral concussion is the most common head injury seen in children.^{[citation needed]}

Intracranial hemorrhage

Main article: Intracranial hemorrhage

Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area.

Intra-axial hemorrhage

Main article: cerebral hemorrhage

Intra-axial hemorrhage is bleeding within the brain itself, or cerebral hemorrhage. This category includes intraparenchymal hemorrhage, or bleeding within the brain tissue, and intraventricular hemorrhage, bleeding within the brain's ventricles (particularly of premature infants). Intra-axial hemorrhages are more dangerous and harder to treat than extra-axial bleeds.^[3]

Extra-axial hemorrhage

Hematoma type	Epidural	Subdural       v d e
Location	Between the skull and the dura	Between the dura and the arachnoid
Involved vessel	Temperoparietal locus (most likely) - Middle meningeal artery Frontal locus - anterior ethmoidal artery Occipital locus - transverse or sigmoid sinuses Vertex locus - superior sagittal sinus	Bridging veins
Symptoms	Lucid interval followed by unconsciousness	Gradually increasing headache and confusion
CT appearance	Biconvex lens	Crescent-shaped

Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes:

• Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma. It may result from laceration of an artery, most commonly the middle meningeal artery. This is a very dangerous type of injury because the bleed is from a high-pressure system and deadly increases in intracranial pressure can result rapidly. However, it is the least common type of meningeal bleeding and is seen in 1% to 3% cases of head injury .
  • Patients have a loss of consciousness (LOC), then a lucid interval, then sudden deterioration (vomiting, restlessness, LOC)
  • Head CT shows lenticular (convex) deformity.
• Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater.
  • Head CT shows crescent-shaped deformity
• Subarachnoid hemorrhage, which occur between the arachnoid and pia meningeal layers, like intraparenchymal hemorrhage, can result either from trauma or from ruptures of aneurysms or arteriovenous malformations. Blood is seen layering into the brain along sulci and fissures, or filling cisterns (most often the suprasellar cistern because of the presence of the vessels of the circle of Willis and their branchpoints within that space). The classic presentation of subarachnoid hemorrhage is the sudden onset of a severe headache (a thunderclap headache). This can be a very dangerous entity, and requires emergent neurosurgical evaluation, and sometimes urgent intervention.

Cerebral contusion

Main article: Cerebral contusion

Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. Complications may include cerebral edema and transtentorial herniation. The goal of treatment should be to treat the increased intracranial pressure. The prognosis is guarded.

Diffuse axonal injury

Main article: Diffuse axonal injury

Diffuse axonal injury, or DAI, usually occurs as the result of an acceleration or deceleration motion, not necessarily an impact. Axons are stretched and damaged when parts of the brain of differing density slide over one another. Prognoses vary widely depending on the extent of damage.

Signs and symptoms

Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurologic deficit.

Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur.

Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headache and a lucid interval, during which a patient appears conscious only to deteriorate later.^[4]

Symptoms of skull fracture can include:

• leaking cerebrospinal fluid (a clear fluid drainage from nose, mouth or ear) may be and is strongly indicative of basilar skull fracture and the tearing of sheaths surrounding the brain, which can lead to secondary brain infection.
• visible deformity or depression in the head or face; for example a sunken eye can indicate a maxillar fracture
• an eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerve that innervates eye muscles
• wounds or bruises on the scalp or face.
• Basilar skull fractures, those that occur at the base of the skull, are associated with Battle's sign, a subcutaneous bleed over the mastoid, hemotympanum, and cerebrospinal fluid rhinorrhea and otorrhea.

Because brain injuries can be life threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation. The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.

The Glasgow Coma Scale is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Glasgow Coma Scale is used in young children.

Causes

Common causes of head injury are motor vehicle traffic collisions, home and occupational accidents, falls, and assaults. Bicycle accidents are also a cause of head injury-related death and disability, especially among children. Wilsons disease has also been indicative of head injury. ^[5]

Diagnosis

See also: Head injury criterion

The need for imaging in patients who have suffered a minor head injury is debated. A non-contrast CT of the head should be performed immediately in all those who have suffered a moderate or severe head injury,an MRI is also an option.^[6]http://www.jpmsonline.com/jpms-vol1-issue3-pages78-82-oa.html

Management

See also: Traumatic_brain_injury#Treatment

Most head injuries are of a benign nature and require no treatment beyond analgesics and close monitoring for potential complications such as intracranial bleeding. If the brain has been severely damaged by trauma, neurosurgical evaluation may be useful. Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit.

Prognosis

In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million.^[7]

In some cases transient neurological disturbances may occur, lasting minutes to hours. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer's disease later in life.^[8]

Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit spinal immobilization via application of a cervical collar and possibly a long board.

If the neurological exam is normal this is reassuring. Reassessment is needed if there is a worsening headache, seizure, one sided weakness, or has persistent vomiting.

References

1. ^ Anderson T, Heitger M, and Macleod AD (2006). "Concussion and Mild Head Injury". Practical Neurology 6 (6): 342–357. doi:10.1136/jnnp.2006.106583. http://pn.bmj.com/cgi/content/extract/6/6/342. Retrieved 2008-01-23. 
2. ^ McCaffrey RJ (1997). "Special Issues in the Evaluation of Mild Traumatic Brain Injury". The Practice of Forensic Neuropsychology: Meeting Challenges in the Courtroom. New York: Plenum Press. pp. 71–75. ISBN 0-306-45256-1. 
3. ^ Seidenwurm DI (2007). "Introduction to brain imaging". In Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Philadelphia: Lippincott, Williams & Wilkins. pp. 53. ISBN 0-7817-6135-2. http://books.google.com/?id=Sossht2t5XwC&pg=PA53&lpg=PA53&dq=extra-axial+intra-axial. Retrieved 2008-11-17. 
4. ^ "Head Injury: Description". Seattle Children's Hospital. http://www.seattlechildrens.org/child_health_safety/health_advice/head_injury.asp. Retrieved 2008-01-07. 
5. ^ National Safe Kids Campaign (NSKC) (2004). "Bicycle injury fact sheet" (pdf). NSKC. http://www.preventinjury.org/PDFs/BICYCLE_INJURY.pdf. Retrieved 2006-12-19. 
6. ^ "www.nice.org.uk" (PDF). NHS. http://www.nice.org.uk/nicemedia/pdf/CG56NICEGuideline.pdf. Retrieved December 12, 2008.  Computed tomography (CT) has become the diagnostic modality of choice for head trauma due to its accuracy, reliability, safety, and wide availability. The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes.
7. ^ Hamilton M, Mrazik M, Johnson DW (July 2010). "Incidence of delayed intracranial hemorrhage in children after uncomplicated minor head injuries". Pediatrics 126 (1): e33–9. doi:10.1542/peds.2009-0692. PMID 20566618. 
8. ^ Small, Gary W (2002-06-22). "What we need to know about age related memory loss". British Medical Journal 324 (7352): 1502–1507. doi:10.1136/bmj.324.7352.1502. PMC 1123445. PMID 12077041. http://bmj.bmjjournals.com/cgi/content/full/324/7352/1502#B21. Retrieved 2008-11-13. 

External links

• Brain Injury The official research journal of the International Brain Injury Association (IBIA)
• Cochrane Injuries Group: systematic reviews on the prevention, treatment and rehabilitation of traumatic injury
• First aid advice for head injuries from the British Red Cross

v d e Nonmusculoskeletal injuries of head (head injury) and neck (S00–S19, 850–854) Intracranial see neurotrauma Extracranial/ facial trauma eye: Black eye  · Eye injury · Corneal abrasion ear: Perforated eardrum Either/both Penetrating head injury M: EYE anat(g/a/p)/phys/devp/prot noco/cong/tumr, epon proc, drug(S1A/1E/1F/1L) M: EAR anat(e/p)/phys/devp noco/cong, epon proc, drug(S2)

v d e General wounds and injuries (T08-T35, 870-949) General Wound/ trauma Blunt trauma/ superficial/closed Abrasion (Avulsion) Blister (Blood blister • Coma blister • Delayed blister • Edema blister • Fracture blister • Friction blister • Sucking blister) Bruise/Hematoma/Ecchymosis (Battle's sign, Raccoon eyes, Black eye, Subungual hematoma, Cullen's sign, Grey Turner's sign, Retroperitoneal hemorrhage) Animal bite: Insect bite · Spider bite Penetrating trauma/open Animal bite: Snakebite · Lizard bite Ballistic trauma Foreign body In alimentary tract (Bezoar) Other Burn/Corrosion/Chemical burn · Frostbite · Traumatic amputation By region Hand injury · Head injury · Chest trauma · Abdominal trauma M: INT, SF, LCT anat/phys/devp noco(i/b/d/q/u/r/p/m/k/v/f)/cong/tumr(n/e/d), sysi/epon proc, drug (D2/3/4/5/8/11)

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