March 22, 2023
In South Africa, like many countries around the world, head injuries are amongst the most common types of injuries that occur.
Dr. Coceka Mfundisi is a neurosurgeon at Busamed Modderfontein Private Hospital. She says a head injury is any type of impact (regardless of force) to the skull (cranium), scalp or brain. This includes mild bumps like banging your head on a surface, to a traumatic brain injury that results from a car accident or a fall from a dangerous height.
“There’s a number of injuries that can happen to the brain itself upon impact. One of the injuries is called a diffuse traumatic brain injury in which the brain is shaken within its rigid box (cranium). In this type of injury, the long fibers of the brain (called axons) tear and it is possible that the brain itself shifts and rotates inside the skull.” And may cause symptoms ranging from headache, dizziness, Loss of balance or memory.
Dr. Mfundisi says a diffuse traumatic brain injury may result in a concussion that affects the axons and cells of the brain. A concussion is what happens when the force of impact (stemming from the injury) reaches the brain. The result of a concussion might leave a person with a mild headache, dizziness and vomiting. They may suffer imbalance immediately after the incident. She adds that a severe concussion might cause one to lose consciousness and this could be fatal if not managed well. “This is why we recommend that concussed person be protected by being removed from the place of injury and be assessed by a health care worker.”
Another type of brain injury that could occur is a blood clot forming in the brain itself. “This is called an intracerebral hematoma,” says Dr. Mfundisi. “It occurs when the brain knocks itself against the skull and thus sustains a bruise. Hematomas or contusions can vary in size from tiny ones that present with a salt- and pepper-like appearance (on a CT scan) to a massive clot that can be fatal.”
Dr. Mfundisi says bleeding can occur not only in the brain but also in the spaces between the cranium and the brain. The elderly and very young are at higher risk of contusions, she says.
“In elderly patients, their brain generally shrinks as they reach their golden years and therefore the space between the brain and its covering is bigger. So, when they have a minor fall at home, the brain will be shaken, which in turn places the blood vessels under tensile strain resulting in them having small tears that leak over a period of time causing a blood clot.”
Patients with a brain bleed/clot could display a rapid or slow deterioration. They might experience loss of consciousness, stroke, headache, and other impairments, says Dr. Mfundisi.
Another type of blood clot that might occur in the brain is called an extradural hematoma. She says this hematoma sits on the dura of the brain and not in the brain matter itself. People with this injury typically will lose consciousness and after some time will be awake. Depending on size, the hematoma may be operated on and the blood clot drained.
It is important to remember that head trauma also includes skull fractures. Dr. Mfundisi says in children – particularly infants and toddlers – depressed skull injuries could lead to brain bruising. If a child falls off the bed or couch, a major consideration would be growing skull fractures as the child gets older.
Dr. Mfundisi is a well-known advocate for the public awareness of using seat belts at any time a person is traveling in a vehicle. This includes backseat passengers and passengers traveling in older model minibus taxis which do not have seat belts for passengers.
“When a person is unrestrained by a seatbelt and they get injured in a road traffic accident, the data shows that they tend to be ejected out of the window of the vehicle. When we as physicians and surgeons then try to assess the critical nature of your injuries, we cannot predict well, the injury of an ejected person versus a restrained one. We advocate for seatbelts because we can better predict what types of injuries you might have sustained in the vehicle by using the data provided by crash tests. For example, if you were restrained with a seatbelt, we know that you would have been thrown forward and then pulled back. We would then look out for related spine injuries. Maybe your spine has shifted, you might have a whiplash, you might possibly have a concussion because you might have moved your head in the accident. So, we can make good assumptions about the healthcare you should get because you’re in a contained situation. When you’re ejected from the car, any number of unplanned injuries could have happened to you, and we would take longer to diagnose and therefore treat. Delay in treatment is associated with poorer outcomes.
Six symptoms of head injury that need immediate medical attention, according to Dr. Mfundisi:
1. Loss of consciousness.
2. Nausea and vomiting.
3. Imbalance and unsteady on their feet.
4. A headache that does not improve, that gets worse when lying down or that feels like changing pressure inside the head.
6. Skewed face, eyes that don’t focus, and having one side of the body present with weakness (this could be a sign of stroke).
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