Each year over a million people visit UK hospitals with a head injury. Approximately 135,000 of those will have to be admitted because of the severity of their injury.
Severe head injuries usually mean that the brain has been damaged in some way. Despite the protective bone covering of the skull, the brain surface can get torn and bruised as it sheers against the skull, and blood vessels and nerves can rip. These injuries can cause bleeding, swelling or fluid build-up in the head, putting pressure on the brain and sometimes causing brain damage.
Road traffic accidents are one of the most common causes of severe head injuries.
Classifying the severity of a head injury
A severe head injury, if not correctly diagnosed and treated, can cause serious damage to the brain. The Glasgow Coma Scale (GCS) is a way of assessing how severely your brain has been damaged, following a head injury. It scores you on your verbal responses, your physical reflexes and how easily you can open your eyes. A score can range from three to 15.
A score of three means that you cannot open your eyes and you cannot respond verbally or physically. This means that your body is in a deep coma (a sleep like state when your body is unconscious for a long period of time). A score of 15 means that you can carry out physical commands, you know who you are, where you are and why you are there, and your eyes are open.
If you have a GCS scale of eight or less, your head injury is generally considered severe. If it is between nine and 12, then the injury is moderate, and if the score is 13 or more, the injury is considered minor.
Types of head injury
If your skull is fractured in a head injury, this will usually heal naturally by itself. The healing process can take many months.
If the fracture is very severe, or has resulted in pieces of the skull bone being pushed inwards then you will require an operation to help realign the skull and prevent any damage being caused to the brain.
If your head injury has caused internal bleeding (haemorrhage), then this must be treated urgently. Uncontrolled bleeding, puts pressure on the brain, which may result in serious brain damage, and in severe cases, death.
This type of internal bleeding is typically treated by a surgical procedure known as a craniotomy whereby a section of skull bone is cut away to allow access to the cause of bleeding. Any damaged blood vessels will then be repaired and any blood clots removed that would have otherwise restricted circulation of blood to the brain.
Following a craniotomy for a serious head injury, a patient may be placed on a ventilator and/or kept heavily sedated until their condition is more stable and any swelling of the brain is under good control.
Severe head injuries can cause serious complications. This is mainly because a serious injury to the head can potentially damage the brain, sometimes permanently. In particularly severe cases, a serious head injury can result in death. This is why your condition is so closely monitored when you are admitted to hospital with a head injury. If you are closely monitored then any complications which arise can be dealt with more promptly and effectively.
Complications of a serious head injury
If your skull is fractured during your head injury then it may increase the risk of you developing an infection. Skull fractures can occasionally tear the membrane (thin layer of cells), which surrounds the brain. If this membrane then becomes infected with bacteria, it can, in some cases, lead to meningitis. This is a potentially fatal condition, which can affect your whole nervous system.
A coma is when you are unconscious and unresponsive for a prolonged period of time. Some people who have severe head injuries may enter into a coma. Most comas only last a few days or weeks, although they can last for years.
Many people recover from comas. However, in some severe cases the patient never regains consciousness, or goes into a vegetative state. A person in a vegetative state may seem to be awake and may show some limited physical response, but they have no awareness of their surroundings and are incapable of feeling mental distress or physical pain.
A severe head injury can damage the brain in several ways, which can lead to a variety of complications. Some types of brain damage are only temporary. Others result in lasting, permanent damage.
The effects of brain damage fall into five main categories.
- Physical effects - such as weakness, stiffness, loss of coordination and paralysis.
- Hormonal effects - some people who have moderate and severe head injuries may damage the working of the pituitary gland. This may in turn lead to low production of hormones such as testosterone, and this can cause erectile dysfunction (impotence). Testosterone treatment successfully treats this consequence of damage to the pituitary gland.
- Sensory effects - you may notice that your senses are affected following a head injury. For example, you may have ringing in your ears, blind spots, double vision or a bitter taste in your mouth.
- Cognitive effects - this is when your ability to think, reason, process information and problem solve is affected. You may experience problems with your memory, particularly your short-term memory. You may also experience difficulty with your speech and communication skills.
- Emotional or behavioural effects - after a severe head injury, you may notice a change in your behaviour as feelings of restlessness, irritation and anger, selfishness and stubbornness, or a tendency to laugh or cry more than before.
The London Brain Centre has a rapid access facility with 24 hour cover for any patient or patients GP who wish to organise an urgent referral for treatment.
The London Brain Centre team are also available to offer 2nd opinion or take over the case of any patient, where additional resources to deliver optimum care and rehabilitation to patients suffering with an existing brain injury would be of value.