Written By: Dr. Jassin Jouria
A 69-year-old female presents to the Emergency Room after slipping on some ice while trying to get her mail this morning. She describes landing on her bottom but thinks that she may have also hit the back of her head after landing. She complains of pain ‘a slight headache’, and also endorses some nausea followed by one episode of vomiting. The emergency room physician immediately orders a CT scan of the brain to evaluate for a head bleed.
Head Trauma From A Mechanical Fall- Some Statistics
Head trauma is often a consequence of a mechanical fall. In the US, traumatic brain injuries following falls have increased by more than 17% between 2008 and 2017. In 2017, the total number of traumatic brain injuries following falls in the US was more than 17,000.
Types of Head Trauma From a Mechanical Fall
Your brain is one of the most important organs of your body. While the hard skull provides strong protection, you can still undergo significant trauma following a fall.
The nature of head trauma can range from a simple concussion to bleeding inside the brain (intracranial hemorrhage).
1- Concussion
In addition to your skull, your head is surrounded by a layer of fluid called the cerebrospinal fluid (CSF), which offers an additional layer of protection. When you suffer a blow to your head, your head bounces around inside the fluid and hits your hard skull. As a result, you may experience symptoms of a concussion like headache, a transient loss of consciousness, or a transient loss of memory.
2- Injuries to the Skull
Your skull bones can break following a mechanical fall. The patterns of a skull fracture can include:
- Linear skull fracture: These are the least traumatic types of skull fractures. It means that there has been a break in the bone but the bones have not moved from their place. These kinds of fractures do not require surgery.
- Depressed skull fracture: As the name suggests, the skull bone gets sunken following the trauma. It requires surgery for the correction of the abnormality.
- Diastatic skull fracture: These skull fractures usually occur in newborns and infants. In this fracture pattern, the fracture occurs along the suture lines. Sutures are the structures where skull bones meet each other. This fracture pattern may or may not require surgery.
- Basilar skull fracture: The base of the skull joins your brain to other structures like your airways, nose, and eyes. This is the most serious type of skull fracture and requires urgent surgical intervention.
3- Intracranial Hemorrhage
Intracranial hemorrhage (ICH) is another grave consequence of head trauma from a fall. It may or may not be associated with a skull bone fracture. The patterns of intracranial hemorrhage include:
- Epidural hematoma: Dura is a thick layer that surrounds the brain. Epidural hematoma means blood collection between the brain and the dural sheath. It requires surgery to remove the blood.
- Subdural hematoma: In this type, the blood exists underneath the dural sheath but still outside the brain itself. It requires surgery to remove the blood as well.
- Intracerebral hematoma: This is the most serious type of brain bleed that involves bleeding inside the brain itself. It requires urgent neurosurgical input.
Danger Signs to Look Out For
Head trauma from a fall is a shocking experience for the sufferer and the other people involved. The most important thing is to remain calm and look out for some warning signs indicating that the person involved requires immediate medical assistance. In addition to the below-mentioned danger signs, you must always seek expert advice for health-related matters.
You should seek medical assistance if someone had a fall with a head injury and now they are:
- Finding it difficult to stay awake or keep their eyes open
- Having a seizure
- Experiencing a problem with their vision or hearing
- Facing issues with their balance, slurred speech,
- Having a bleed or discharge of clear fluid from your nose or ears
- Undergoing changes related to their eyes like bleeding or one pupil being bigger than the other
- Coming across changes like numbness or loss of power in your limbs
- Experiencing vomiting and headache
- Noticing a bump on their head
In addition, anyone with head trauma should seek immediate medical assistance if:
- They experienced a dangerous mechanism of fall. For example, falling from more than one-meter height.
- They are on a blood thinner.
How Do Doctors Assess and Treat Head Trauma From a Mechanical Fall?
Once you go to your nearest Accident and Emergency (A&E), your doctor will assess you for a head trauma using the following steps:
- The doctor will take a detailed history trying to understand the situation and mechanism of the fall. They will also ask questions about the medical background and the list of medications, including blood thinners.
- They will quickly rule out the danger signs to prioritize those who require urgent investigations and treatment.
- They will carry out a detailed physical examination to check for any signs of bleeding, obvious skull injury, or symptoms related to brain damage (like unequal pupils).
- After stabilizing the patient, they will order a series of scans including CT scans and MRI scans of the head and face. These scans are meant to look for any bone injuries and to look for any bleed inside or outside the brain.
- Based on the symptoms from physical examination and the extent of skull and brain damage, the doctors might then refer the patient to neurosurgeons for further assessment and management (including surgery to remove blood from around the brain).
- If the patient is unstable or unconscious, the doctors might refer them to intensive care. The patient is stabilized until review by the neurosurgeons.
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367089/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/head-injury
https://www.cdc.gov/headsup/basics/concussion_danger_signs
https://www.nhs.uk/conditions/head-injury-and-concussion/
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