Fortunately, most falls or blows to the head result in injury to the scalp only, which is usually more frightening than threatening. A scalp injury can bleed extensively, since the scalp is rich with blood vessels. The "goose egg" or swelling that may appear on the scalp after a head blow results from the scalp's veins leaking fluid or blood into (and under) the scalp. It may take days or even weeks to disappear.

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Serious head injuries may have no obvious external signs, but cause internal bleeding and swelling that puts pressure on the brain tissue. It may be caused by a hard blow to the head, a fall onto the base of the spine that jars the brain, a whiplash injury, violent spinning of the head, or an injury that penetrates the skull. The more force involved in a head injury, the bigger the likelihood of serious injury to the brain.

Signs
The following signs may indicate a significant head injury:

• Unconsciousness that persists longer than one minute
• Altered level of consciousness, which may present as confusion, drowsiness, uncharacteristic behaviour or irritability
• The person goes to sleep and you cannot rouse them
• Memory loss after the first five minutes (see box: How to test)
• Weakness of the limbs, or problems walking
• Violent or persistent vomiting.
• Seizure
• Pupils of unequal sizes
• Blurry or double vision after the first minute
• Slowed breathing rate
• Severe, persistent headache
• Blood or clear fluid from the ears or nose (excluding a nosebleed caused by a blow to the nose)

Signs of a brain injury may appear immediately, or develop slowly over several hours. Usually, signs will occur within three days after a blow to the head, but in rare cases they may even manifest weeks later.

Signs of concussion are discussed below.

Get help immediately if:

• The person loses consciousness at any time after the injury, even if it was brief.
• There are signs of a serious brain injury (See “Signs”).
• You suspect there has been neck or spinal damage.
• If the person continues to vomit after the first 15 minutes after an injury or if vomiting occurs after the first 2 hours. (Children often vomit once or twice soon after an injury).
• There is an open gaping scalp wound.

Home treatment

• If the victim is unconscious, assume that he or she has a spinal injury. Do not move the victim. Suspect a spinal injury after any severe blow to the head, even if the person is conscious.
• Apply firm pressure with a cloth to a bleeding head wound.
• Apply ice or cold packs to reduce any swelling.
• After any blow to the head, keep a close eye on the person for the next 24 hours. Every 2 hours, check for the following (even during the night – wake them up to do the checks): difficulty in waking up, confusion and memory loss (ask questions as set out below), difficulty speaking, inability to move limbs, blurred or double vision, unequal pupil size (test response with flashlight). If any of these symptoms appear, or if there are any vomiting or seizures, the person should be seen by a doctor immediately.
• Check for injuries to other parts of the body.
• Encourage a person who has suffered even mild concussion to rest for a few days.

Prevention:
Use seat belts and car child seats every time you drive, no matter how short the distance. Wear a helmet when taking part in sports or activities in which you may fall or knock your head, such as cycling or rock climbing, and never dive into murky or shallow water. Make your home fall-proof. Wear sensible shoes, especially if you are older.

Concussion
Concussion is a head injury that produces an altered mental state, with, or without a loss of consciousness. Concussion sufferers look and act dazed, have a vacant stare and a confused facial expression. They are slow to answer questions and follow instructions. Distractibility and confusion is common. Slurred or incoherent speech, a lack of coordination, and memory loss indicates a more severe concussion – so do a loss in consciousness, even if brief.

The symptoms of mild concussion disappear quickly, but more serious injuries can produce headaches, dizziness, nausea and mental fogginess that last for hours or days. A person with severe concussion may suffer from fatigue, low-grade headaches, poor memory and concentration, disturbed sleep, irritability and depression for several weeks or even months.

All persons with concussion should see a doctor. Further contact sports should be avoided until a doctor has given permission to do so. A second head injury soon after concussion may lead to brain swelling and even death.
 

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