21. Head injury

Every year Accident and Emergency departments see large numbers of patients with traumatic head injuries, some including brain injuries. These brain injuries are usually mild, and the vast majority of these patients do not develop any acute 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. A brain injury may be accompanied by damage to the neurocranium and base of the skull, which in turn can lead to cranial nerve damage, hearing loss and leakage of CSF. A minor traumatic brain injury can give rise to lasting post-traumatic symptoms that affect day-to-day life. If a patient survives a severe traumatic brain injury, the severity of the residual disability will often be determined far more by mental and cognitive than physical sequelae. Traumatic brain injury can be classified in various ways, based on clinical parameters (sect. 21.3.1), the location of the trauma damage to the skull and brain (local or diffuse, sect. 21.3.2), and progression over time (primary or secondary, sect. 21.3.3). This classification is important for diagnosis, treatment and the ultimate prognosis. The diagnosis and treatment of patients with head injury needs to be standardized to enable optimum recovery (sect. 21.1 and 21.4). The aim must be the prompt identification of neurosurgically treatable cranial and intracranial abnormalities (sect. 21.5 and 21.6) that could cause increased intracranial pressure (sect. 21.3.4), herniation (Chap. 20) and ultimately a poorer outcome or even death. The prognosis for traumatic brain injury (sect. 21.7) will depend on the severity of the injury (clinical and radiological), and there is an association with certain neurodegenerative disorders in later life (sect. 21.7.4).