Severe head injury

A severe head injury needs urgent medical assessment, because there's a risk of serious, permanent brain damage.

It can be hard to tell a minor head injury from a severe one.

Read about minor head injuries

You or someone else has a head injury and:

• doesn't respond to their name or a gentle chest rub
• cannot stay awake
• has had a seizure (fit)
• has fallen from a height, like 5 or more stairs
• has problems with their senses, like hearing loss or double vision
• has numbness or weakness in any part of their body
• is struggling to walk, balance, speak, write, or understand other people
• hit their head with force, like being hit by a car
• has a head wound with something inside it, like glass
• has signs of damage to their skull, like a dent in their head
• has severe neck pain or cannot move their head

Go to the hospital emergency department if you or someone else has a head injury and:

• is confused or was 'knocked out' for any length of time
• has vomited
• has a persistent headache that is not helped by painkillers
• is showing unusual behaviour, like being very irritable or crying more than usual
• has memory loss (amnesia)
• is intoxicated due to alcohol or recreational drugs
• has a blood clotting disorder (haemophilia) or takes blood thinning medicine (like warfarin or apixaban)
• has previously had brain surgery
• has a large bruise or wound to the head or face
• has a black eye
• has blood or clear fluid coming from their ears or nose
• has bruising behind their ears
• the injury wasn't accidental, for example if someone else has hurt a child on purpose

A person with a severe head injury should be seen in a hospital emergency department.

The doctors and nurses treating you will deal with any life-threatening injuries first. Once you're stable, they'll ask you some questions, which can help them diagnose and treat your injury.

If someone saw your accident happen, it helps if they come to hospital with you and describe what happened.

A doctor will check how well your brain is working using the Glasgow Coma Scale (GCS). It shows how serious your severe head injury is. The score is based on whether you can open your eyes, speak, and move your body.

You may also have a computerised tomography (CT) scan. This gives a detailed picture of the inside of your head, and it shows whether there's any bleeding, bruising or swelling in your brain.

Doctors don't do skull x-rays anymore, because they give no information about brain damage.

If a person is confused, they may find it hard to cooperate with a CT scan. In that case, they may need anaesthesia so the scan can be done and so their brain injury doesn't get worse.

Some people who have a severe head injury go into a state of reduced consciousness. Confusion, drowsiness and coma are all examples of this.

It can last for a few days, weeks or even years. Other things, such as alcohol or drugs, can cause it too.

Whether someone recovers, partly or fully, depends on the cause.

If a person is in a state of reduced consciousness, the medical professionals treating them can sometimes tell you more about:

• their current state
• how likely they are to recover

What happens next depends on your injury and on what the doctors find when they examine you. You may be:

• admitted to hospital for more tests and treatment
• allowed to go home after the examination
• sent home and told to attend follow-up appointments at your local neurological centre or head injury clinic

Head wounds often bleed a lot, and the bleeding can be heavier if you're taking anti-coagulant medicines like warfarin or apixaban.

Any cut or graze on your head will be treated to stop further bleeding and to prevent infection. If something is lodged in the wound, such as broken glass, it will need to be removed.

Deep or large cuts may need to be closed with glue, stitches or staples until they heal. The doctor may use a local anaesthetic to numb the area around the cut, so you don't feel any pain.

If you need to be observed after a severe head injury, the doctors and nurses looking after you will check you again and again at regular times. They will look at:

• your level of consciousness and how alert you are (using GCS)
• the size of your pupils and how well they react to light
• how well you can move your arms and legs
• your breathing, heart rate, blood pressure, temperature and the level of oxygen in your blood

These checks give the medical team a bedside assessment of how your brain injury is progressing.

Neurosurgery means any surgery used to treat problems of the nervous system, that is, problems with the brain, spinal cord and nerves. Most head injuries heal by themselves, so they don't benefit from neurosurgery.

If surgery is needed, a neurosurgeon (a specialist in brain surgery) may speak to you or your family first.

Some problems, though, need urgent treatment, and there may not be time to talk about the surgery before it's carried out. When that happens, your surgeon will discuss the operation with you or your family afterwards.

Someone who has neurosurgery is likely to need close monitoring after the operation, and a long rehabilitation period.

Your skull can be fractured during a head injury. A skull x-ray isn't much use here, because it tells you very little about any injury to the brain. A CT scan is the better test, and it helps the doctors work out how far the injury goes.

Most skull fractures heal by themselves, especially simple, linear fractures. Healing can take many months. You may have a headache for a few weeks, and over-the-counter painkillers should ease it.

Because a severe head injury can do so much damage, serious complications can follow. These can sometimes be permanent.

Complications can include:

The brain and its lining can become infected (meningitis). You may be offered a vaccination to prevent this happening.

There are many reasons why a brain injury can happen. It can be temporary or permanent. The effects are difficult to predict, but could include:

• headaches and tiredness
• problems with your memory
• difficulty moving, keeping your balance, or with co-ordination
• loss of your sense of taste and smell
• changes in your vision, including blind spots
• difficulty thinking, processing information and solving problems
• difficulty with speech and communication
• changes to your normal feelings and behaviour
• aggression or loss of inhibitions
• epilepsy

Some people have the symptoms of concussion for a long time after the first injury. This is called post-concussion syndrome.

When you've recovered enough to go home, you'll need someone to take you. Don't drive until you've completely recovered.

If you're sent home less than 24 hours after your injury happened, someone will need to stay with you until that time has passed. The reason is to watch for any problems that might appear.

You may be advised not to take your blood thinning medicine for a short period.

Don't stop taking any medicine that's been prescribed without checking with your doctor or another healthcare professional first. You could make yourself very ill.

You may be advised to see your doctor in the week after you leave hospital, so they can check how you're coping.

You may also have a follow-up appointment at a head injury clinic. This will usually be with a specialist in head injury.

Depending on your injury, you may be offered different treatment to help you recover. This could include:

• physiotherapy, to help with physical problems like weakness, stiffness or poor co-ordination
• occupational therapy, to help you if you're struggling with everyday tasks
• speech therapy
• psychological therapy, to help you cope if your injury has affected your mental wellbeing