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Severe Head Injury

Severe Head Injury

A severe head injury is a condition where the head experiences a collision or hard pressure that causes bleeding or severe damage to the brain. If not dealt with quickly and accurately, this condition can be fatal.

A severe head injury, also called a severe concussion, can be caused by many things. Traffic accidents and physical violence are some of the incidents that often cause a person to suffer a severe head injury.

Based on the cause, head injuries can be divided into two types, namely:

  • Closed head
    injury Closed head injury can occur as a result of a collision or a hard blow to the head. This condition causes injury to the brain tissue but the skull bones are still intact.
  • Open head injury or penetrating wound
    This condition can occur as a result of an impact that causes the bones of the skull to break. It could also be because something penetrated or punctured the bones of the skull and brain, for example a bullet shot to the head.

Causes of Severe Head Injury

Severe head injuries can occur as a result of blows, pressure, punctures, or hard blows to the head. Some of the events that can cause severe head injuries are:

  • fall
  • Injuries while exercising
  • Traffic accident
  • Physical violence
  • Detonate explosives or other materials

Risk factors for severe head injury

Severe head injuries can happen to anyone. However, severe head injuries are more likely to be experienced by:

  • Men
  • Children, especially those less than 4 years old
  • Young adults, especially those aged 15–24
  • Elderly (elderly), who are 65 years old and above
  • Athlete
  • Construction worker
  • Motorcyclists

Symptoms of Severe Head Injury

Severe head injuries can cause a variety of symptoms, both physical and mental. Symptoms can appear immediately, a few hours, or a few days after the injury occurs.

The following are some physical symptoms that sufferers of severe head injury may experience:

  • Turn
  • Severe headache
  • Stiffness in the neck
  • Difficult to speak
  • Difficulty breathing
  • It is difficult to move some parts of the body
  • Bruising and swelling around the eyes or around the ears
  • Damage to the bones of the skull or face
  • Sensory disturbances, such as hearing loss or double vision
  • Continuous vomiting and sputtering
  • Blood or clear fluid coming out of the ear or nose
  • Disorientation or not being able to recognize time, place, and people
  • Inability to move arms or legs
  • Changes in the size of the pupil of the eye
  • Convulsions
  • Loss of consciousness
  • Amnesia

Meanwhile, mental symptoms that can be experienced by a severe head injury include:

  • Get angry easily
  • Feeling anxious or depressed
  • Disturbances in memory and concentration
  • Behavioral change

In children, the symptoms that appear can be:

  • Changes in diet or breastfeeding
  • Changes in sleep patterns
  • Fussy
  • Melancholy
  • Loss of interest in favorite activities or toys
  • It's hard to stop crying
  • Loss of focus
  • Looks sleepy
  • Convulsions

When should you go to the doctor?

If you see someone around you suffering a collision or injury to the head to the point that there are symptoms indicating severe head injury, immediately take them to a doctor , especially if the person is experiencing more serious symptoms, such as respiratory arrest.

You can give first aid while waiting for medical help to arrive. Some of the efforts that can be made are:

  • Do not change the patient's position, such as changing the position of the neck or removing the helmet from the head.
  • Stop the bleeding by pressing the bleeding part using gauze or a clean cloth. However, do not do that if there is a possibility that the sufferer will suffer a broken bone.
  • Perform CPR if the victim is not breathing or has no pulse.

A person with the following conditions should be immediately taken to a doctor if they experience a collision or injury to the head:

  • Have undergone brain surgery
  • Clear fluid or blood coming out of the ear or nose
  • Having a seizure
  • Consuming alcoholic beverages or previous medications, especially medications that can cause blood clotting disorders, such as warfarin
  • Have had a blood clotting disorder
  • Suffering injuries as a result of a hard impact, for example as a result of being hit by a high-speed car or falling from a height of more than 1 meter
  • Being injured as a result of something intentional, such as being hit by another person
  • There is something stuck in the head

Diagnosis of Severe Head Injury

As an initial step, the doctor will perform first aid to stabilize the patient's breathing, heart rate, and blood pressure. After the patient's condition is stable, the doctor will ask several questions related to the symptoms and events that could be the cause of the head injury.

If the patient is unconscious, the doctor can ask the person who took the patient to the hospital. After that, the doctor will perform a thorough physical examination on the patient, including a neurological examination.

The doctor will use the Glasgow Coma Scale ( GCS ) to assess consciousness and identify the severity of the patient 's head injury. The GCS value is determined based on three factors, namely:

  • Verbal response
  • Physical movement
  • Eye opening

The value of each factor above will be added up to produce a total value. Based on this total value, head injuries are classified into three levels of severity, namely:

  • Mild head injury : the total value is in the scale 13–15
  • Moderate head injury: the total score is in the 9–12 scale
  • Severe head injury: the total score is on a scale of 8–3

A value of 15 (the highest value) indicates that the patient is fully conscious, can open his eyes spontaneously, speak, and receive instructions. While scale value 3 (the lowest value) shows the patient in a coma .

If necessary, the doctor will perform a supporting examination, such as a CT scan or MRI, to obtain an image of the broken bone and detect bleeding in the brain, blood clots (hematoma), bruised brain tissue (contusion), or swelling of the brain tissue.

Treatment of Severe Head Injury

Generally, severe head injuries require intensive care in hospital to reduce the risk of complications. Some treatment methods that can be used to deal with severe head injuries are:

First aid

When giving first aid to a patient with a severe head injury, the doctor will usually do some of the following actions:

  • Check breathing, heart rate, and blood pressure
  • Perform cardiopulmonary resuscitation (CPR) when the patient has respiratory arrest or cardiac arrest
  • Stabilize the neck and back with a neck brace or back brace
  • Stop the bleeding
  • Give intravenous fluid to prevent hypovolemic shock due to bleeding
  • Immobilize a cracked or broken bone
  • Prescribe pain relievers


Once the patient's condition is stable, the doctor will suggest observation in the intensive care unit. The medical staff will perform regular checks on the following factors:

  • Level of consciousness
  • The size of the pupil of the eye and its reaction to light
  • How well the patient moves his arms and legs
  • Breathing, heart rate, blood pressure, body temperature, and oxygen levels in the blood


The doctor will perform an operation when a patient with a severe head injury experiences one or more of the following conditions:

  • Brain hemorrhage
  • Blood clots in the brain
  • Bruising on the brain (cerebro contusion)
  • Fractured skull
  • There are foreign objects, such as broken glass or bullets

One of the types of surgery that doctors can perform is craniotomy, which is by opening the bones of the skull. The stages performed by the doctor in the craniotomy procedure are:

  • Making a hole in the skull bone as access to the brain
  • Removes blood clots that may form and repair blood vessels in the damaged brain
  • Put the piece of skull bone back in its original position after the bleeding in the brain has stopped, then attach it with a special nut

Treatment of skull fractures

Severe head injuries are sometimes accompanied by skull fractures. If the fracture experienced is classified as severe, this condition risks causing infection and increasing pressure on the brain . The doctor may do some of the following to deal with it:

  • Give antibiotics if an open fracture occurs to prevent infection
  • Perform an operation to repair a broken bone or remove bone fragments that are in the brain

However, if the skull only has a small crack, the above actions may not be necessary. This is because the condition generally recovers on its own within a few months.


In severe head injury patients, the doctor will perform several therapies to help the patient in carrying out normal daily activities. Some of the complications are physical therapy (physiotherapy), occupational therapy, and speech therapy.

The chance of recovery of a patient with a severe head injury depends on how quickly the treatment is given. The sooner the condition is treated, the higher the chance of recovery.   

Complications of Severe Head Injury

If not treated immediately, a severe head injury can cause damage to the brain and cause serious complications that can be fatal. Complications can be temporary or permanent.

Some of the complications that can occur as a result of a severe head injury are:

  • Brain infection , due to a fractured skull that tears the thin protective layer of the brain
  • Disturbance of consciousness, such as coma , or a condition where the patient appears conscious but not responsive ( vegetative state )
  • Post-head injury syndrome, which results in sleep disturbances, memory disturbances, and poor concentration
  • Injury and damage to the brain, which can cause epilepsy , impaired balance and coordination of body movements, as well as difficulty thinking
  • Brain death

Prevention of Severe Head Injury

Events that can cause severe head injuries tend to occur suddenly so that it is difficult to prevent completely. However, there are several things that can be done to reduce the risk of head injury, namely:

  • Use the right personal protective equipment when driving a motor vehicle and when exercising.
  • Avoid driving under the influence of alcohol or drugs that can affect alertness.
  • Make sure the house is free of things that could make you fall, such as items scattered on the floor or slippery carpets.
  • For the elderly, be careful in doing daily activities because there is a risk of falling due to a decrease in the ability to maintain body balance.
  • Make sure the house is safe for children, for example by keeping windows or balconies out of children's reach.
  • Avoid placing babies or toddlers in high places without supervision.
  • Avoid shaking the baby too hard .
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