Head injury history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurologic deficit.

Patients with a concussion may have a history of being unconscious for seconds to minutes followed by a normal return to consciousness. Disturbance of vision and equilibrium may also occur.

Common symptoms of head injury include those indicative of traumatic brain injury:

• Loss of consciousness
• Confusion
• Drowsiness
• Personality change
• Seizures
• Nausea and vomiting
• Headache
• A lucid interval, during which a patient appears conscious only to deteriorate later

Symptoms of a skull fracture can include:

• Leaking cerebrospinal fluid (a clear fluid drainage from the nose, mouth or ear) may be and is strongly indicative of a basilar skull fracture and the tearing of sheaths surrounding the brain, which can lead to secondary brain infection.
• Visible deformity or depression in the head or face; for example a sunken eye can indicate a maxillar fracture
• An eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerve that innervates eye muscles.
• Wounds or bruises on the scalp or face.
• Basilar skull fractures, those that occur at the base of the skull, are associated with Battle’s sign, a subcutaneous bleed over the mastoid, hemotympanum, and cerebrospinal fluid, rhinorrhea, and otorrhea.

Because brain injuries can be life threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation. The caretakers of those patients with mild trauma, who are released from the hospital, are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.

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