Mar 23, 09 | Posted by: Michelle Linsmeier, M.D.

Is it a bump or a serious head injury?

I was reading my People magazine tonight (ok, it’s been a long weekend, and I needed some “light” reading)!  The cover story was about Natasha Richardson and her tragic death following a head injury.  I know that questions about falls and head injuries are some of the most common phone calls that I receive each week.  With summer approaching soon, I thought it seemed like a good time to talk about head trauma and what to watch for.

First, I think it’s important to understand what we are talking about when we say “head trauma”, “bleeding on the brain” and “hematoma”.  Head trauma is a vague term that describes any time of injury (from minor bump to severe bleeding).  More specific to head trauma is the area in which bleeding can occur.  OK, quick anatomy lesson:  there are multiple layers of  tissue and blood vessels that surround the brain inside of the skull.  There are also more blood vessels , along with muscles, fat and other tissues that are outside the skull under the skin.  Severe head injuries occur when blood vessels within the skull are damaged and start to bleed.  There is limited amount of space inside the skull between the bone and the brain for blood to accumulate.  After a certain amount of blood forms, it pushes on the brain causing severe complications, possibly death.  This is unfortunately what happened to Ms. Richardson – her bleeding occurred inside the skull and increased to such a point that the volume of blood pushed against her brain (because her skull is “fixed” in place), causing her ultimate death.  Severe head bleeds are usually called epidural hematomas, subdural hematomas and subarachnoid hemorrhages.

Most of the time, a injury to the head causes bleeding outside the skull.  The blood vessels leak blood into the space, and cause the large bump/ goose-egg/ knot on the forehead or other area of the head.  Other than being sore to the touch, and maybe causing a mild headache, these do not cause any long term problems.

So, how do you know when it is only a mild goose-egg or a severe head injury?  When do you need to seek medical attention? 

1. Excessive irritability or sleepiness.  Everyone is crabby after they hit their head.  This is referring to the child or infant that you cannot calm or soothe.  This is the baby that is still crying hysterically 30-45 minutes after the fall or injury without stopping to eat, play or snuggle with mom.  Excessive sleepiness?  Chidren may be tired after a fall and crying in pain for 5-10 minutes.  It is a problem, though, if you can’t  wake them or have them come to be fully alert and responsive. 

2. Recurrent vomiting.  Some infants and children may vomit immediately after a head injury.  This is fairly common.  The concern comes if the vomiting persists, or starts later after the fall.  Always seek medical advice if the vomiting is persistent or begins more than 30 minutes after the injury. 

3. Increasing headache.  As I wrote above, most of us will have some head pain/ headache after a head injury.  It is a problem if the headache is worsening over time.

4. Unsteady balance or movements.  If your 4 year old can’t walk straight or your toddler falls down every time he takes a step after an injury, the best thing to do is have them evaluated.

5. Disorientation or confusion.  Simple questions have confusing or garbled answers, or the child can’t recognize who/ where they are.

6. Seizure activity. (enough said)

If you are unsure, contact your healthcare provider or seek an evaluation at the emergency department.  Thankfully, the majority of head trauma evaluations end up being nothing more than a bump to the head and a bruise or two.  All it takes is a horrible tragedy like the one to Ms. Richardson to remind us to play it safe and have it checked out to be sure.

As a final note: PLEASE INSIST THAT YOUR CHILD WEAR THEIR HELMET FOR ANY TYPE OF HIGH IMPACT ACTIVITY!  This includes riding their bike (even in the driveway – that concrete/ black top is just as hard as the street stuff), riding their scooter, roller-blading, ice skating and skiing.  Be a good example – put yours on too! It can truly save a life!

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