Head trauma refers to any damage to the scalp, skull or brain caused by injury.

Head
injury may be classified in various different ways according to the type of injury,
which structures in the head are damaged or how severe the trauma is.

Closed or open injury

One way head injuries are classified is according to whether the injury is open or
closed.

Closed injury
A closed injury refers to damage that does not break the skull or penetrate the brain
tissue. Although the skull is not broken, this type of injury can still cause brain
damage in the form of swelling or bruising, for example.

Open injury
An open injury refers to damage that penetrates the skull causing problems such as
bleeding in the brain, skull fracture or the pressing of bones against structures in the
brain. This type of injury is more likely to occur when a person is moving at high
speed, when colliding with a windscreen during a car accident, for example. A
gunshot to the head would be another example.

Concussion
This form of head injury occurs when the brain is shaken, which may or may not
involve a blow to the head. The effects of concussion range from headache to loss of
consciousness.

Primary or secondary lesion

Head injury may be classified according to the type of lesion involved. The two main
types of lesion that occur in head trauma are primary lesions and secondary lesions.
Primary lesions occur as a direct result of initial injury to the head causing
displacement of the physical brain structures. Secondary injuries occur over time and
may involve several cellular processes rather than mechanical damage. Secondary
lesions can occur as a result of the primary lesion or they may be unrelated to it.

Primary injury
Primary injury is injury that occurs as a direct result of the initial head trauma.
Examples of primary injury include contusion (bruising or hematoma), vascular
damage, and axonal shearing (torn and stretched nerve axons). Primary injury can
damage the blood–brain barrier and meninges and lead to neuronal death, which may
occur in a random manner. Different brain areas may sustain different levels of
damage depending on their sensitivity to mechanical loading. Two main causes of
primary injury are a blow to the head received by an object and the brain hitting
against the inside of the skull.

Secondary injury
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A secondary injury is one that is not mechanically induced but occurs as a result of
the primary injury causing complications such as inadequate blood flow in the brain
(ischemia), reduced availability of oxygen (hypoxia) in the brain, low blood pressure,
increased intracranial pressure (pressure inside the skull), or swelling in the brain
(cerebral edema). Other causes of secondary injury include meningitis, brain abscess,
increased carbon dioxide levels, free radical damage, and acidosis.

Head trauma severity

Head trauma is also classified according to how mild or severe it is, which affects
how the injury is managed.

Mild injury
Mild head injuries are common amongst all age groups. Symptoms are usually short
lived, with no permanent damage caused. Examples of symptoms include:

 Mild headache
 Poor balance or trouble standing
 Confusion
 Nausea
 Dizziness
  Small cut or bump
 Ringing in the ear
 Mild blurring of the vision
 Temporary amnesia

People who experience any of these symptoms after a mild knock or blow do not
usually require treatment, but should visit their local accident and emergency
department for a check- up.

Severe head injury

Some of the indications of severe head injury include:

 Bleeding from deep wounds in the scalp

 Unusual eye movement
 Loss of consciousness
 Inability to focus
 Poor muscle control
 Vomiting
 Convulsion

Serious head injuries require immediate medical attention so that any bleeding or
brain damage can be accurately assessed and treated.

Treatment depends on what type of injury a person has and their overall state of
health and ability to withstand treatment. Treatments range from drug therapies to
address seizures or bleeding, through to surgery to reduce bleeding, swelling in the
brain or pressure inside the skull.