Earlier this week, a healthy nine-year-old Bloemfontein boy suffered a seemingly harmless bump on the head while rough-housing with his friends. Except for some slight dizziness, he seemed fine. Four days later, his anguished parents lost him to cerebral haematoma – bleeding inside the skull.
When does a bump on the head call for a kiss to make it better, and when does it necessitate an immediate visit to the doctor? According to Prof. Peter Rose-Innes, retired Head of Neurosurgery at Tygerberg Hospital, this is one type of injury about which parents need to be especially vigilant.
Says Prof Rose-Innes: "There are many possible medical scenarios after a serious blow to the head. A blow that leads to a haematoma usually results in unconciousness straight after the injury – but not always. Basically, bleeding may be extra-dural (between the dura, the protective layer around the brain, and the skull); subdural (between the dura and the brain); or it may occur within the tissue of the brain itself, in which case it is called intracerebral.
"As the bleeding exerts increasing pressure on the brain, the brain reacts by swelling. The skull does not allow much space for the brain tissue to expand, and damage can quickly result. The brain's functioning slows down and eventually leads to unconsciousness."
More common than haematoma, however, is cerebral oedema, which can also result from a blow to the head. In this condition, there is no bleeding, but the 'shake-up' the brain receives provokes the brain cells themselves to swell with fluid. The resultant pressure reduces blood supply to the brain by compressing the blood vessels, and distorts the brain tissue. Cerebral oedema is a risk associated with almost any significant head injury.
When to take a bump on the head seriously
If a child (or equally an adult) receives a blow to the head that results in unconsciousness for any length of time, even if it's only 30 seconds, it should always be taken seriously, says Prof Rose-Innes.
"A child who is unconscious for longer than just a couple of minutes needs to not only see a doctor at once, but also usually needs to be monitored in an expert observational unit for a few days. This is not one of those times when you can just stay at home and hope for the best because the child seems to have recovered.
"Even if the child has transient unconsciousness (unconscious for less than 30 seconds to a minute), or no obvious unconsciousness – but they display any disturbance of their normal mental awareness, then they should be seen by a doctor. It's generally a good idea to rest for at least 24 hours after a bad blow to the head, and to keep an eye on the child."
Symptoms to watch out for
Symptoms of cerebral haematoma or oedema can become apparent some time after a blow to the head. Usually, however, they will occur within a week, and most commonly about three days after the injury. The following are important warning signs, and warrant an immediate call to your doctor:
- Any change in mental functioning is the most significant indication. This could show up as confusion, disorientation, sleepiness, changes in the child's normal interaction with other people, slowed responsiveness, incoherence.
- Any speech disturbance e.g. slurring, inability to speak normally.
- Any weakness of a limb or the face.
- Any vision disturbance e.g. vision loss, blurring, zig-zag lines.
- Nausea or vomiting.
(Olivia Rose-Innes, Health24)