Closed Head Injury
Sorry, these's no room left
After falling and
cracking your head on a rock, after a sudden violent stop, your brain
can be severely damaged . . . even if
there is no apparent harm done to the outside of your head! Knowing how
to recognize that you, or a friend, have a head injury, and knowing what
to do about it, may prevent permanent disability ... or death.
Back when hunting was a way of life for everyone, tiny human brains enjoyed
a simple life with few responsibilities ...breathing, digestion, translating
primitive messages from the senses, keeping the body semi-erect. Thick
skulls barely lifted above prehistoric eyebrows. There was nothing up
there to fill a larger space. Then, suddenly, about 30,000 years ago,
a mere drop in the bucket of earth time, an unexplained period of rapid
brain growth began, a period that continues today. Brain evolution focused
on the cerebrum, the gray matter, the part most people think of when they
think brain. The other two main divisions of the brain, the cerebellum
(for coordination) and the brain stem (for vegetative functions), haven't
changed much. What you've got now is a big brain inside of a big head,
somewhere between 16 and 22 pounds of head, the average weight range for
an adult's bowling ball, and it's supported by a relatively skinny neck.
What you've got now is an invitation to an accident.
Unfortunately, your brain is a fragile and easily damaged organ, susceptible
to all sorts of injuries and deprivations. Fortunately, it lives inside
protective plates of bones, fused strongly together, forming a natural
helmet called the skull, or cranium.
Your brain takes up about eight/tenths of the space inside your skull.
Most of the rest of the space is filled with blood vessels and cerebrospinal
fluid (CSF), a dense, clear, colorless substance. CSF flows around the
outside of the brain, through a latticework of fibers. Working together,
fluid and fibers form the brain's primary shock absorption system, protecting
the brain from the bumps and jiggles of everyday life. But, if your head
smacks into something with sufficient force, your brain can slosh around
enough to tear some of the blood vessels, and even bruise the brain itself,
if it hits the inside of the skull. That's how you can have brain damage
without headbone damage.
What happens inside the head is this. Blood flows out of the broken blood
vessels in the head and, sometimes, blood serum starts to leak out of
the vessels in the damaged area of the brain. Swelling results, but, unlike
the rest of the body, there's no place for the swelling to go. As the
space inside the head decreases, there is less and less room for the flow
of life-sustaining blood. Initially, the brain stops making CSF, and starts
to reabsorb what is already there . . . the brain tries to create more
space. The brain can even limit the amount of blood flowing to itself.
But, if the damage is sufficient, the brain's compensatory mechanisms
cannot keep up with the swelling. Intracranial pressure (ICP) starts to
rise, and, as a result, the brain is squashed.
You, or your friend, may have been bonked on the head, but 1) you never
lost consciousness, or 2) the period of unconsciousness was brief, less
than five minutes, which is called a concussion. Victims with this type
of non-serious head injury may have difficulty remembering what happened,
but the memory should return in about 30 to 45 minutes. However, there
are certain signs of trouble which may appear, usually within 24 hours,
rarely as long as away as 48 hours. The appearance of any one of these
signs is reason to seek a physician's care as soon as possible.
1) CSF and/or
Bleeding from Nose or Ears. Any drainage of clear fluid, or clear fluid
mixed with blood, from nose or ears indicates a crack in the skull, which
justifies quickly finding a physician.
2) Excessive Drowsiness. The injured person may be exhausted, but, if
they go to sleep, it should be easy to arouse him with methods you would
ordinarily use to awaken someone. If you can't arouse him, pressure is
developing inside his head, and he needs a doctor.
3) Persistent Vomiting. It is common to vomit after a blow to the head.
Should the victim vomit several times, or start vomiting hours later,
he may have increasing intracranial pressure. Find a doctor.
4) Unusual Bruising. The appearance of bruises around the eyes (Raccoon
eyes) or behind and below the ears (Battle's sign) indicate bleeding inside
the head. This victim needs a physician.
5) Pupil Irregularity. If one pupil grows larger and less responsive than
the other, pressure is developing on the side of the brain that controls
the altered pupil. Seek a physician.
6) Loss of Coordination. If walking becomes unsteady, or if the victim
loses the ability to use his arms and legs normally, he may have pressure
increasing on his cerebellum, the center of coordination. He needs a doctor's
7) Speech Difficulty. If the victim loses the ability to speak, or if
his speech becomes slurred, it might be from pressure on the cerebrum
where the speech control center resides. Take him to a hospital.
8) Severe Headache. A headache that keeps getting worse is one sign of
increasing pressure inside the victim's head. A doctor should be consulted.
9) Double Vision. If the victim starts to complain of any doubling of
vision, or any failure of his eyes to move normally or focus normally,
he may have damage to the back of his brain where messages from the eyes
are interpreted, or pressure developing on an optic nerve. He needs to
see a physician.
10) Seizures. Should a seizure (convulsion) occur, not an uncommon result
of increasing intracranial pressure, protect the victim from injuring
himself further during the event, place him on his side after the seizure
to keep his airway open, and, as soon as possible, find a doctor.