Head Injury Can Cause Cerebral Haemorrhage, Even Hemiplegia

Dr. TSANG Chun Pong

Specialist in Neurosurgery

Head injuries often occur in contact sports or when one falls, resulting in skull fracture, even cerebral concussion. Sequela is also possible if headache persists for quite some time after the accident.

Possible Brain Damage due to Head Injuries   

Head injuries fall into 2 main groups: blunt injuries and penetrating injuries. The former occur when the head hits a hard object or surface, e.g. when one falls and hits the road. The latter are common in accidents where the head is struck by a fast/slow-moving object, and the force is so strong that causes skull fracture, even intracerebral damage.

People suffering blunt or penetrating injuries may feel dizzy and headache after the accident. Possible brain damage includes:

- Intracerebral haematoma/cerebral haemorrhage: the intracranial pressure increases as blood begins to accumulate inside the cranium. And one may be unconscious after the accident.

- Open brain injuries: infection occurs when bacteria from the skin goes inside the brain

- Cerebrospinal fluid leak in case of basal skull fracture and tear of meninges

The Glagsow Coma Scale is used to rate the severity of brain injuries. It ranges from 3 to 15, with 14 to 15 for mild injuries, 9 to 13 indicating moderate injuries, and 3 to 8 suggesting severe injuries; whereas GCS 3 means coma.

When dizziness or seizure preceding the fall occurs, patients may fail to protect themselves and suffer more severe head injuries. The same situation may occur if they are on aspirin or anti-coagulants at the time of the accident.  

Injury Site and Impaired Function

Brain function impairments vary with injured brain areas. For example, speech and limb impediments may occur if the speech and motor areas suffer severe damage.   

The olfactory nerve is located in the forward part of the brain, and one can lose smell if the head injury causes basal skull fracture. The auditory nerve and facial nerve are within the temporal bone. Face paralysis may occur if the facial nerve is impacted, or hearing impairment if the auditory nerve is damaged. Sphenoid fracture, though uncommon, may result in impaired eyesight because of injury to the optic nerve.

Skull Structure

Brain Areas and their Functions

Even Mild Haemorrhage can have Severe Consequences

The human brain atrophies with age. Spaces between the skull bones increase as the brain shrinks inside the skull. Despite mild or moderate head injuries, the blood clots thus formed are degraded and turned into liquid. The liquefied blood clots may expand in volume and compress on the brain, leading to chronic subdural haematoma. It usually occurs from few weeks to months after the initial injury. Patients with chronic subdural haematoma may be less responsive and may have unstable gait. Even hemiplegia may occur if severe. Immediate medical attention and brain imaging examination are thus recommended.   

Chronic Subdural Haematoma under CT

Carers should note that even a mild impact can cause cerebral haemorrhage in the elderly, especially if they are on antiplatelets or anticoagulants. Patients should also beware if recovery seems to slow down, or slow response / discomfort occurs 1 or 2 months after head injury.

Fontanelle in Infants

A “fontanelle” is like an opening in a newborn’s skull because there the bones have not fused together. The spaces between the bones allow the baby’s skull to fit through the birth canal and move during delivery. The bones will later merge together as the child grows.

Infant Skull Structure

The spaces between the skull bones afford an advantage to newborn in terms of head injuries: they allow the brain to expand and reduce the pressure when there is hematoma developed. However, since the bones are also less developed than those of adults, the infant skull and brain are thus less able to withstand the impact.

Most skull fractures in adults take 4 to 6 weeks to heal. Neurosurgery is performed when there is open skull fracture or significant depressed skull fracture.

Limit Injury with Early Examination and Surgery

During consultation, your doctor will first observe any clinical symptoms such as slurred speech or limping. If necessary, either CT or MRI examination will be arranged to study the extent of cranial damage and confirm bleeding in the brain. 

For treatment of chronic subdural haematoma, surgery is recommended when it results in significant compression on the brain. During the procedure, one or more small holes are drilled in the skull to drain the haematoma. 

Neurosurgery is also recommended for other severe brain injuries. For example, craniotomy is carried out to remove blood clots and return the intracranial pressure to normal. And if the increase in pressure is caused by brain swelling, surgeons may perform decompressive craniotomy to reduce the intracranial pressure. Part of the skull is removed during the procedure to allow space for brain expansion.  

As brain damage are mostly irreversible, the purpose of neurosurgery is to prevent “second damage”, i.e. to limit the extent and degree of brain damage as well as to minimise the impact of primary injury on the remaining brain areas.  

Mininise Impact with Proper Head Protection

Nothing is more important than head protection in preventing brain damage. Always buckle up while driving or riding in vehicles. To reduce impact during accident, a helmet should be worn while cycling or skateboarding.  

With support from carers, seniors are less likely to fall or trip if they walk at a slow, steady pace. Also seek immediate medical attention if anything unusual is noticed in their condition.