20. Head and brain injuries

Every year Accident and Emergency departments see large numbers of patients with head injuries, some including brain injuries. These brain injuries are usually mild, and the vast majority of these patients do not develop any complications. It is important to provide good-quality standardized care in the acute phase, as a very small proportion of these patients develop potentially severe intracranial complications that can be fatal if not diagnosed and treated in time. Brain injuries can be classified into two types, diffuse and focal. A head injury may be accompanied by damage to the neurocranium and base of the skull, which in turn can lead to cranial nerve damage and leakage of CSF. If a patient survives a severe brain injury, the severity of the residual disability will be determined far more by mental and cognitive than physical sequelae.