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Drawing by Charles Bell (1774-1842). From "The Anatomy of the Brain," one of a series of  engravings originally published in London in 1802.

Head injuries: Tips to know when they are dangerous

by Alina Dain
April 09, 2009

Seek medical attention after a head injury if you experience:

• Loss of consciousness
• Trouble with balance
• Lethargy
• Seizure
• A black eye
• Blood leaking out of an ear or trouble hearing
• Severe headaches
• Blurry vision
• Nausea or vomiting
• Trouble speaking
• Difficulty using one side of the body such as arm and leg weakness.

Sources: Dr. Andrew M. Naidech, co-medical director of the Neuro Spine ICU, Northwestern Memorial Hospital, and Dr. Richard E. Temes, director of neurological critical care at Rush University Medical Center

Spring brings lots of bumps and bruises and no one takes a child to the doctor for every skinned knee.

But overlooked head injuries that need medical attention can be dangerous.

Chicago physicians stress that children and the elderly are more likely to suffer serious head injuries caused by trauma to the brain.

The news of actress Natasha Richardson’s untimely death due to head trauma helped save 7-year-old Morgan McCracken of Ohio from a similar life threatening head injury. Doctors recommend cautious scrutiny after a head injury for anyone if a person experiences symptoms such as blurry vision, headaches, or nausea.

But Richardson’s symptoms were not evident at first, though brain trauma had occurred. Traumatic brain injuries account for approximately 50,000 deaths annually, according to the National Center for Injury Prevention and Control. The number of people with such injuries who go untreated is unknown.

Children and teenagers are prone to injuries from athletic activities, said Dr. Richard E. Temes, director of neurological critical care at Rush University Medical Center, while the elderly can slip and fall. Such injuries can be particularly dangerous.

“In young children, the skull isn’t fully hardened, and they are typically less coordinated,” Naidech said.

“The elderly are more likely to have brain bleeding from even small amounts of trauma,” Naidech said, adding that these types of injuries are quite common, and the range of injury runs from inconsequential to fatal.

Elderly patients injured in the head from a fall will most commonly suffer from a subdural hematoma, said Temes. A vain pops on the surface of the brain and bleeding occurs. The condition develops slowly as the blood clot that forms gradually expands.

“It’s not unusual, especially with elderly patients who fall, for this to go on for days and weeks,” Temes said.

Trauma is an umbrella term for any external force that leads to brain damage, said Dr. Andrew M. Naidech, a co-medical director of Northwestern Memorial Hospital’s Neuro Spine ICU. 

Another type of injury, Temes said, is an epidural hematoma, the injury believed to have caused Richardson's death. A brain injury or skull fracture causes an artery to burst. This causes bleeding between the skull and the fibrous dura, a covering around the surface of the brain.

The danger with such an injury is that arteries bleed very quickly, within minutes and hours, Temes said, while the symptoms seem very mild at first.

“A simple headache doesn’t seem important and people don’t seek out medical attention, but the bleeding is ongoing,” Temes said.

Unless the cause of an injury is obvious, such as gunshots to the head or motor vehicle accidents, the most important screen for traumatic brain injury is an examination by a competent health care professional, Naidech said.

If patients get medical attention quickly, an easy surgery that can remove the blood. Temes said. Otherwise, the blood on the surface of the brain expands so quickly that it causes increasing pressure and the patient goes into a coma. People taking blood thinners or aspirin are especially susceptible because the ability of the blood to clot is impeded.

“The patient seems normal and then, in a matter of moments loses consciousness,” Temes added. “Natasha Richardson seemed fine but during this time bleeding was continuing, and it just became too late.”