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How to Tell Whether a Bump on the Head Is Serious

Bob Saget’s tragic death drives home the danger of brain injuries. After a bump or blow to the head, it’s essential to know what to do and what to watch for. That’s because head injuries can put dangerous, sometimes deadly, levels of pressure on the brain.

Ian Crain, MD, is the director of the Brain Injury Center at Banner – University Medical Center Phoenix and a sports neurologist who specializes in traumatic brain injuries (TBIs) and concussions. Here, he shares what you should know about head injuries.

What causes head injuries?

Anything that strikes or jolts your head could cause a traumatic brain injury. For example:

  • A knock against a cabinet or shelf
  • A misstep getting into or out of a car
  • A fall
  • Play-wrestling with a child that leads to a bump
  • A collision with another player during sports
  • A car accident

Traumatic brain injuries can be mild, moderate or severe. Mild traumatic brain injuries are also called concussions.

What are the signs of a brain injury?

With a simple bump on the head, you might notice a lump with some pain and bruising. But it’s important to watch for signs that your injury is more serious. If you have a brain injury, you might:

  • Lose consciousness
  • Lose memories from around the time of the injury, called post-traumatic amnesia (For example, if you’re in a car accident, you may remember the car coming toward you, then the next thing you remember is being in an ambulance. In between, you may answer questions appropriately, but you don’t form memories.)
  • Ask the same questions over and over again
  • Feel like you’re in a fog or like everything is moving in slow motion
  • Feel off-balance or dizzy
  • Have difficulty focusing

With more severe injuries, you might notice:

  • Vision loss
  • Slurred speech or nonsensical words
  • An inability to understand speech
  • Have the worst headache of your life, a headache that is worsening, or a headache with two or more episodes of vomiting

Take note of any signs that your brain doesn’t seem quite right. Most people with signs of a mild traumatic brain injury, or concussion, don’t lose consciousness or memories. “Since most people don’t have loss of consciousness or post-traumatic amnesia, what we look for is some kind of alteration in consciousness,” Dr. Crain said.

The tricky thing about brain injuries is that symptoms don’t always appear right away. “Brain injury is called the invisible injury because many times you can appear okay from the outside and have this lucid interval, where there are no signs that anything is wrong. But then hours later you can rapidly develop symptoms,” he said.

How is a head injury linked to bleeding?

Sometimes, a blow to the brain can cause internal bleeding between the brain and the skull. This bleeding happens when the blood vessels in or around the brain get torn. They may bleed slowly, so you may not have symptoms right away. “You hit your head, and maybe you have a little bump or bruise, but you feel fine,” Dr. Crain said. “You go about your business, but as that blood builds up, you can start to show symptoms.”

You’re at higher risk for bleeding around the brain when your brain is smaller. That’s because a smaller brain leaves more space between your brain and your skull, and the blood vessels that stretch between them get stretched tight. “If you have some kind of shaking of the brain, it can pull on them and pop them,” Dr. Crain said. The blood can compress the brain, and if it presses on the brain’s respiratory center, it can be life threatening.

You may be more likely to experience bleeding after a brain injury if you:

  • Are 60 or older, since your brain shrinks with age
  • Use alcohol or drugs
  • Have genetic risk factors that may make your brain smaller
  • Take blood thinners, aspirin or nonsteroidal anti-inflammatories like ibuprofen
  • Have other medical conditions such as Alzheimer’s disease

What should you do if you suspect a brain injury?

If are experiencing any of the symptoms outlined above and you suspect a brain injury, you can seek care from:

  • An athletic trainer if the injury occurred while playing a sport and one is available
  • The nurse line or on-call doctor with your primary care provider
  • Telemedicine or virtual visits
  • Urgent care centers or emergency rooms or departments
  • 911, if you call an ambulance

These health care professionals can evaluate your condition, symptoms, age, and other risk factors and determine whether you need further care. They may also recommend a CT scan to look for signs of bleeding. It’s also important to note that in some states, like Arizona, student-athletes who have a concussion are required by law to be treated by an athletic trainer or medical doctor trained in evaluation and treatment of concussions before they can return to play.

How should you treat a mild head injury at home?

You may not need to seek medical care for a simple bump. You can check on a child with a mild head injury periodically, but there’s no need to wake them unless you notice abnormal breathing. You may have heard that you shouldn’t let someone with a concussion fall asleep. But that’s outdated advice—resting helps the brain heal.

Because older adults have smaller brains and are at higher risk for bleeding, you want to watch them more closely. Sleep is beneficial, but it’s a good idea to check on them briefly once an hour or so to make sure they’re OK. If they appear to be normal, you can let them continue to sleep.

If you notice abnormal breathing or any alterations in mental state, contact a health care professional for advice. And don’t leave someone with a suspected brain injury alone. If they become confused, unfocused or off-balance, they may not be able to seek help on their own. Most head injuries do not need any intervention, but if there is ever any doubt, get checked out.

How can doctors treat brain injuries?

For concussions, doctors may recommend rest at home. However, more severe injuries that cause pressure inside the head, either from swelling or bleeding, may need care in a hospital. In those cases, doctors may elevate the head of the bed to help alleviate the pressure. They may also give you sodium through an IV to help reduce the pressure in your head. Medication can help lower the pressure on the brain and help preserve brain function. In severe cases, surgeons may need to drain fluid out of the skull or remove part of the skull to alleviate the pressure.

What’s the recovery process like for brain injuries?

With a mild traumatic brain injury, your symptoms might worsen within the first three days then get better over the next few weeks, but recovery can take up to three months. The Banner Concussion Center encourages active recovery, promoting early activity and return to normal life as safe as possible. You shouldn’t have any permanent symptoms if a concussion is treated. But Dr. Crain points out that even a mild traumatic brain injury is significant. “It can be safe to treat it at home, but it’s something to be taken seriously, not dismissed.”

With a moderate or severe traumatic brain injury, your length of recovery could be longer, and there might be some long-term effects or permanent symptoms.

The bottom line

Anytime you strike your head, you could develop a dangerous brain injury. If you have signs of one or are concerned you may have had a traumatic brain injury, it is important to watch for symptoms and seek medical help. If you need advice right away, visit bannerhealth.com and click on Get Care Now in the upper right corner.

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