Head Injury
What is a head injury?
A head injury is any injury to the head that may affect the brain, ranging in severity from mild to severe.
Severe head injuries require urgent medical assessment because of the risk of permanent brain damage.
It is not always easy to distinguish a mild injury from a serious one immediately after an accident; therefore, any head injury with concerning signs should be assessed promptly by a specialist.
When is urgent medical help needed?
Seek urgent medical attention after a head injury if any of the following occurs:
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The person does not respond to their name or to gentle stimulation.
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The person cannot stay awake.
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The person has had a seizure.
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The person has fallen from a height, for example from five or more stairs.
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There are problems with vision or hearing.
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There is numbness or weakness in any part of the body.
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There is difficulty walking, maintaining balance, speaking, or understanding what is being said.
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The head was struck with considerable force, for example in a road traffic collision.
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There is a head wound containing a foreign body, such as glass.
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There are signs of skull injury, such as a depression.
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There is severe neck pain or an inability to move the head.
Urgent assessment in hospital is also needed if there is confusion or even brief loss of consciousness, a persistent headache not relieved by simple painkillers, vomiting, unusual behaviour, memory loss, a large bruise or wound to the head or face, a black eye, or blood or clear fluid leaking from the ears or nose.
Concussion: how is it different?
Concussion is the mildest form of head injury and does not usually require neurosurgical intervention. However, its symptoms, such as dizziness, headache and confusion, can initially resemble those of a more serious injury. For this reason, every head injury merits medical assessment to exclude a more serious problem.
Diagnosis
Assessment of a serious head injury begins with the Glasgow Coma Scale, which estimates injury severity according to the patient’s ability to open their eyes, speak and move.
A CT scan of the head is the principal imaging investigation, as it can identify bleeding, contusion or swelling in the brain. Plain skull X-rays are no longer used because they provide no information about possible brain injury.
Neurosurgical management
Most head injuries resolve without surgery. In all cases, the patient is monitored closely, with regular assessment of conscious level, pupil size and reaction to light, limb movement, and vital signs such as breathing, heart rate and blood pressure.
In some cases, when there is significant bleeding, swelling or raised intracranial pressure, neurosurgical intervention is required.
Dr Nektarios Mazarakis assesses each case individually and, whenever feasible, informs the patient or their family before any intervention.
Possible complications
Severe head injuries may be associated with complications, some of which can be permanent. One possible complication is infection of the brain and meninges.
Brain injury may be temporary or permanent, with possible consequences including headache and fatigue; memory problems; difficulty with movement or coordination; changes in vision; difficulty thinking and solving problems; problems with speech and communication; behavioural changes; and epilepsy.
In some patients, symptoms from the initial injury persist for a prolonged period; this is known as post-concussion syndrome.
Recovery and rehabilitation
After discharge from hospital, a review with the treating clinician is usually arranged during the first week, along with follow-up in a specialist head-injury clinic.
Depending on the nature of the injury, physiotherapy may be needed for mobility problems, occupational therapy for difficulties with everyday activities, speech and language therapy, or psychological support where the injury has affected the patient’s mental health.
Book an Appointment
Dr Nektarios Mazarakis assesses patients with head injuries at his clinics in Athens and Thessaloniki.