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24a. Bangs on the Head/Cerebral Trauma. (Update 14 Septr 2021. The below descending list of headings shows chapter content and may be used to search & find or scroll down to.
Bangs on the head are a risk factor for Dementia.
Prevention of head bangs
Varieties of Head Trauma
Concussion
Neuroimaging
What about skull fractures?
Subdural hematoma
In the just-previous chapter it is written that repeated bangs on the head are a risk factor for Dementia. Big bangs and other brain trauma also cause sudden death, brain damage, mental retardation, and various palsies and paralyses.
Prevention of head bangs starts with an alertness to avoid banging one's head on overhead and jutting points. Cultivate a lifestyle without sudden fast movements. Doing everything slow, if started young, will pay off with a better old-age brain. Wearing a long front-visor cap with a button on the top will lessen banging of brow, temple or top of head. When you are looking for a new living space, pay attention to selecting one with minimal head-bang possibilities.
Sports and other physical activities: absolutely never do boxing or other pugilism; but body contact sports are hard to avoid in childhood, and sports is a fun part of it; however, if you (or more likely your child) are going to play football, be sure of good body and head protector and for baseball, wear an anti bean-ball cap. And beware of treadmill accidents such as happened to Facebook CEO's Sheryl Sandberg's husband, Dave Goldberg.
I am not a lover of bicycling, which has been sold to the public as a good exercise habit. It causes too many accidents and many are head injuries. Motorbikes are worse. Wear protective headgear if you must indulge. Cars need the greatest care. In addition to seat belts and air bags, the head protectors are a must, and never drink alcohol, or take marijuana or other drugs within the 24 hours before driving and never drive yourself from your doctor or dentist filled with analgesic or anesthesia drug. (My brother Joe did and almost killed himself and lost his license for a year)
Varieties of Head Trauma: In head trauma, first consider why the brain may be damaged after a head bang. In the head trauma without skull fracture, the first injury to the brain is from acceleration/deceleration. Picture the brain encased in a water jacket separating it from the inside of a hard bony skull that has sharp ridges at its base. Think of yourself pitched forward and striking your brow against a hard ground. The soft brain is accelerated forward as you fall on your brow. Then, as you strike your brow against a sidewalk, the hard skull is suddenly decelerated to a sharp stop but the frontal lobes of your brain keep accelerating forward until they strongly strike the inside of your skull behind your brow. This brain injury in the direction of the acceleration is a coup injury but brain injury may also occur contrecoup, meaning at the opposite pole from the bang point. Because of the architecture of the inside of the skull and the skull's inner ridges both coup and contrecoup injuries involve the front of the brain striking the inner skull behind the brow, so frontal lobe injury is the most common head bang injury from acceleration/deceleration head injuries. This is the reason that personality changes are a frequent symptom of high acceleration bangs
But also, many head traumas include torsion, or twisting, and the mobile brain can get damaged especially at the brain stem or upper spinal cord with horrible results.
Finally, even in mild bangs, just the sharp fluid wave of the bump passing through the brain tissue may disrupt nerve fibers in surrounding tissue; not enough to give noticeable immediate symptom but enough to cause disruption of connections between brain neurons, and when enough connections get disrupted a type of dementia like Alzheimer's develops. This is seen in boxers, who also suffer the acceleration-deceleration and torsion bangs from the punches.
Concussion: Head trauma that does not seem major and is not complicated by fracture of skull is called concussion. Inside the limits given by No fracture and No immediate major sign, the term is vague. When does a concussion start and when is it exceeded? It starts with a bang to the head that causes dizziness, soreness, maybe brief unconsciousness, or just a bad feeling. Often it may not seem to need emergency room. So the practical question is: When to go to the ER? The answer is: Go if you have the slightest doubt. Especially if you are older than age 60 (or a child younger than age 10), have a bruise at the site of the bang, of if you were at all unconscious even if for only a moment. And if you decide to go to the ER, go immediately; do not wait till morning or Monday after the weekend.
Of course, in the ER, you leave all to the professionals, but as a minimum, you ought to get a complete neurological examination, and set of skull x-rays checking for skull fracture. (Basal skull fractures, often missed on the standard 2 skull x-rays, need special basal fracture views.) Most victims of concussion will be sent home and never have a problem but important is instruction to a family member or friend, to return the patient if unduly sleepy, headache, vomiting or other symptoms. Particularly, basal skull fractures show the following signs: drainage of fluid from nose, ear or mouth; pain behind the ears and poor hearing or puffy swelling behind one or both ears; ring of skin darkening around one or both eyes (raccoon sign); and any effect suggesting cranial nerve damage (facial paralysis like Bell's palsy, loss of hearing, any visual loss, crossed eyes, weakness of tongue, loss of taste or smell).
Approach to Head Injury: There is a category of head-trauma brain injury where the patient remains completely conscious. It is often seen in a sports injury. The thing to note or to ask the person who suffers the injury is "Do you have a feeling of being stunned?" ("Seeing stars" or being briefly disoriented to time or place.) Those who answer Yes even in a slight degree should always be checked in an emergency room and almost always have initial CT of the brain because among this type of injury there is a high risk of internal brain bleeding which is easily missed because it seems to have been a very minor trauma.
Neuroimaging majorly includes CT or MRI scans. In this time of emphasis on economic use of medical facilities, doctors may limit these procedures strictly. All head trauma cases should get, at the least, an A-P and lateral head x-ray. Other x-rays, like basal skull fracture views and neck views of upper vertebrae and spinal cord, depend on physical findings and result of initial skull films. If any question of brain trauma (skull fracture, unconsciousness, neurological signs or symptoms), a CT of the head is the first neuroimaging. It is considered more accurate for acute (within few hours) head injuries than MRI. But, after 24 hours, MRI is the most accurate imaging.
It should go without saying (or writing) that when a full clinical neurological exam is done it should be repeated at least once within 24 hrs. The most important symptoms of serious head trauma develop quickly and are usually the cranial nerve signs already mentioned. Sleepiness, headache and vomiting occur much in minor or more serious injuries. The important point is progression; so instructions for home observation should be given.
What about skull fractures? Fracture should be suspected with any strong bang, whenever a bruise or skin tear or bleeding is seen, or if even very brief unconsciousness occurs. It should be confirmed by skull x-ray and then followed by CT of head. The presence of a fracture greatly ups the risk of brain damage. As mentioned, basal skull fractures are often missed unless special x-ray views are done. Any head trauma followed quickly by cranial nerve signs (unilateral deafness, facial palsy, vertigo to one side) often is due to basal skull fracture.
Most head trauma does not show skull fracture. Nonetheless serious brain injury may occur without external signs around the skull and face
This chapter is about victims of head tra uma who retain consciousness or only very briefly (less than a minute) lose and regain it. More severe cases are obvious and do not need a book to tell a person or the doctor that the victim should immediately be transported to a well equipped hospital ER.
The problem of head bang in older persons (above age 60) is high risk of bleeding between the surface of brain and inner skull -subdural hematoma. Especially high risk if the person is taking anticoagulant Coumadin (Warfarin) or heparin or aspirin daily. Even light bumps that show no immediate symptom and are forgotten may lead to later headache, personality change, and eventual stroke-like symptoms. Any old person who bangs his head and feels even slightly bad in the following weeks should get neuroimaging. For a fictionalization treatment of head bang, click 12.(26-28) Girl Talk, a Tumble, and Educate Brend...
End of Chapter. To read next chapter, click: 9.24b Secrets of Neuroimaging
Sports and other physical activities: absolutely never do boxing or other pugilism; but body contact sports are hard to avoid in childhood, and sports is a fun part of it; however, if you (or more likely your child) are going to play football, be sure of good body and head protector and for baseball, wear an anti bean-ball cap. And beware of treadmill accidents such as happened to Facebook CEO's Sheryl Sandberg's husband, Dave Goldberg.
I am not a lover of bicycling, which has been sold to the public as a good exercise habit. It causes too many accidents and many are head injuries. Motorbikes are worse. Wear protective headgear if you must indulge. Cars need the greatest care. In addition to seat belts and air bags, the head protectors are a must, and never drink alcohol, or take marijuana or other drugs within the 24 hours before driving and never drive yourself from your doctor or dentist filled with analgesic or anesthesia drug. (My brother Joe did and almost killed himself and lost his license for a year)
Varieties of Head Trauma: In head trauma, first consider why the brain may be damaged after a head bang. In the head trauma without skull fracture, the first injury to the brain is from acceleration/deceleration. Picture the brain encased in a water jacket separating it from the inside of a hard bony skull that has sharp ridges at its base. Think of yourself pitched forward and striking your brow against a hard ground. The soft brain is accelerated forward as you fall on your brow. Then, as you strike your brow against a sidewalk, the hard skull is suddenly decelerated to a sharp stop but the frontal lobes of your brain keep accelerating forward until they strongly strike the inside of your skull behind your brow. This brain injury in the direction of the acceleration is a coup injury but brain injury may also occur contrecoup, meaning at the opposite pole from the bang point. Because of the architecture of the inside of the skull and the skull's inner ridges both coup and contrecoup injuries involve the front of the brain striking the inner skull behind the brow, so frontal lobe injury is the most common head bang injury from acceleration/deceleration head injuries. This is the reason that personality changes are a frequent symptom of high acceleration bangs
But also, many head traumas include torsion, or twisting, and the mobile brain can get damaged especially at the brain stem or upper spinal cord with horrible results.
Finally, even in mild bangs, just the sharp fluid wave of the bump passing through the brain tissue may disrupt nerve fibers in surrounding tissue; not enough to give noticeable immediate symptom but enough to cause disruption of connections between brain neurons, and when enough connections get disrupted a type of dementia like Alzheimer's develops. This is seen in boxers, who also suffer the acceleration-deceleration and torsion bangs from the punches.
Concussion: Head trauma that does not seem major and is not complicated by fracture of skull is called concussion. Inside the limits given by No fracture and No immediate major sign, the term is vague. When does a concussion start and when is it exceeded? It starts with a bang to the head that causes dizziness, soreness, maybe brief unconsciousness, or just a bad feeling. Often it may not seem to need emergency room. So the practical question is: When to go to the ER? The answer is: Go if you have the slightest doubt. Especially if you are older than age 60 (or a child younger than age 10), have a bruise at the site of the bang, of if you were at all unconscious even if for only a moment. And if you decide to go to the ER, go immediately; do not wait till morning or Monday after the weekend.
Of course, in the ER, you leave all to the professionals, but as a minimum, you ought to get a complete neurological examination, and set of skull x-rays checking for skull fracture. (Basal skull fractures, often missed on the standard 2 skull x-rays, need special basal fracture views.) Most victims of concussion will be sent home and never have a problem but important is instruction to a family member or friend, to return the patient if unduly sleepy, headache, vomiting or other symptoms. Particularly, basal skull fractures show the following signs: drainage of fluid from nose, ear or mouth; pain behind the ears and poor hearing or puffy swelling behind one or both ears; ring of skin darkening around one or both eyes (raccoon sign); and any effect suggesting cranial nerve damage (facial paralysis like Bell's palsy, loss of hearing, any visual loss, crossed eyes, weakness of tongue, loss of taste or smell).
Approach to Head Injury: There is a category of head-trauma brain injury where the patient remains completely conscious. It is often seen in a sports injury. The thing to note or to ask the person who suffers the injury is "Do you have a feeling of being stunned?" ("Seeing stars" or being briefly disoriented to time or place.) Those who answer Yes even in a slight degree should always be checked in an emergency room and almost always have initial CT of the brain because among this type of injury there is a high risk of internal brain bleeding which is easily missed because it seems to have been a very minor trauma.
Neuroimaging majorly includes CT or MRI scans. In this time of emphasis on economic use of medical facilities, doctors may limit these procedures strictly. All head trauma cases should get, at the least, an A-P and lateral head x-ray. Other x-rays, like basal skull fracture views and neck views of upper vertebrae and spinal cord, depend on physical findings and result of initial skull films. If any question of brain trauma (skull fracture, unconsciousness, neurological signs or symptoms), a CT of the head is the first neuroimaging. It is considered more accurate for acute (within few hours) head injuries than MRI. But, after 24 hours, MRI is the most accurate imaging.
It should go without saying (or writing) that when a full clinical neurological exam is done it should be repeated at least once within 24 hrs. The most important symptoms of serious head trauma develop quickly and are usually the cranial nerve signs already mentioned. Sleepiness, headache and vomiting occur much in minor or more serious injuries. The important point is progression; so instructions for home observation should be given.
What about skull fractures? Fracture should be suspected with any strong bang, whenever a bruise or skin tear or bleeding is seen, or if even very brief unconsciousness occurs. It should be confirmed by skull x-ray and then followed by CT of head. The presence of a fracture greatly ups the risk of brain damage. As mentioned, basal skull fractures are often missed unless special x-ray views are done. Any head trauma followed quickly by cranial nerve signs (unilateral deafness, facial palsy, vertigo to one side) often is due to basal skull fracture.
Most head trauma does not show skull fracture. Nonetheless serious brain injury may occur without external signs around the skull and face
This chapter is about victims of head tra uma who retain consciousness or only very briefly (less than a minute) lose and regain it. More severe cases are obvious and do not need a book to tell a person or the doctor that the victim should immediately be transported to a well equipped hospital ER.
The problem of head bang in older persons (above age 60) is high risk of bleeding between the surface of brain and inner skull -subdural hematoma. Especially high risk if the person is taking anticoagulant Coumadin (Warfarin) or heparin or aspirin daily. Even light bumps that show no immediate symptom and are forgotten may lead to later headache, personality change, and eventual stroke-like symptoms. Any old person who bangs his head and feels even slightly bad in the following weeks should get neuroimaging. For a fictionalization treatment of head bang, click 12.(26-28) Girl Talk, a Tumble, and Educate Brend...
End of Chapter. To read next chapter, click: 9.24b Secrets of Neuroimaging
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