The head trauma (TCE) is an impact at the brain level that occurs as a consequence of an external force that can lead to a decrease or alteration of the level of consciousness, which in turn produces a decrease in cognitive and / or physical abilities. In other words, it is any trauma that occurs to the head, whether superficially affecting the scalp or more seriously, affecting the skull and brain tissue..
In addition, head trauma is one of the most common types of acquired brain damage. Specifically, in Spain and in other industrialized countries, head injuries are the main cause of death in young adults.
Trauma can occur when the head is struck or struck suddenly and violently with an object or surface, or when an object pierces the cranial vault and accesses nerve tissue.
Among the most common causes of head injuries are traffic accidents, falls, work accidents, or violent assaults. Signs and symptoms can range on a continuum from mild, moderate, or severe, depending on the extent of nerve damage and injury..
Therefore, the severity can range from a mild bump or contusion to severe bruising in areas of the brain. Specifically, the most common injuries include: contusions, skull fractures or wounds to the scalp.
The consequences and treatment of head injuries vary greatly between different cases, depending on both the cause of the injury and the severity of the injury..
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A head injury or traumatic brain injury occurs when an external mechanical force causes damage and injury to the brain.
When an object violently hits the skull, a wide variety of medical conditions can appear: headache, confusion, lightheadedness, dizziness, blurred vision, fatigue, sleepiness, loss of consciousness, and other neurological and cognitive symptoms..
Due mainly to the structural configuration of the skull, head injuries will cause damage both in the affected areas, that is, those that receive the impact, and in others further away as a result of the blow-back effect..
Head injuries represent an important public health problem due to their frequency in the general population and the consequences or consequences associated with them.
In the United States, each year approximately 230,000 people are hospitalized in emergency departments with severe traumatic brain injuries, while approximately another million people suffer minor or minor traumatic incidents..
Of the severe cases, more than 99,000 people will suffer significant sequelae, making it possible for them to remain in a state of chronic disability.
In addition, head injuries are two to three times more frequent in men than in women, while the age group most affected is the period between 15 and 24 years of age. However, after age 60 the risk also increases.
The most characteristic signs and symptoms in head injuries are physical injuries to the head:
Damage to the brain or nerve tissue may occur at the moment of impact or develop later. Some of the physical injuries resulting from head trauma are:
In addition to these signs that are evident at the time of impact or trauma, there are head injuries that can have important physical or neurological consequences.
Despite the fact that the clinical course is quite heterogeneous, a set of symptoms that appear frequently immediately after the traumatic event or a few days later have been identified..
Specifically, depending on the severity of the traumatic injury, we can distinguish various symptoms:
Signs and symptoms related to mild head injury may affect the physical, sensory and cognitive areas.
In the case of signs and symptoms related to moderate-severe head injury, they will mainly affect the physical and / or cognitive area and may include all those related to mild head injury..
There are numerous events or conditions that can cause traumatic brain damage.
The most common cause of head injury is traffic accidents, accounting for approximately 50% of cases. On the other hand, physical activity and some sports modalities can also cause accidents and are considered the second most prevalent cause.
In addition, routine accidents and falls are another frequent cause, especially in people over 65 years of age..
Other less frequent causes have also been identified such as bullet wounds or employment of forceps during the birth.
Systematically, the most common causes of head injuries are:
There are a wide variety of classification criteria for head injuries: clinical factors, severity, injury produced, etiology, etc..
- Open TCE: when a cranial takes place and the brain tissue is exposed to the outside.
- TCE closed: when there is no open injury and the damage occurs secondary to the traumatic event.
- Encephalic: lesions directly affect brain tissue.
- Cranial: the lesions affect the interior of the skull, but do not involve other secondary ones at the cerebral level.
- Epicranial: lesions affect the outside of the skull.
-Mild TBI: the patient is fully oriented and remains alert. Significant and permanent neurological deficits do not usually appear. Despite this, at the time of the trauma there may be loss of consciousness and post-traumatic amnesia.
-Moderate TBI: in moderate TBI there is a decrease in awareness or alertness and signs of neurological deficits may appear.
-Severe TBI: in the most severe type there is a serious decrease in the level of consciousness. The patient presents totally isolated from the surrounding environment without presenting a response to verbal commands or environmental stimulation. Severe TBIs are associated with both significant brain damage and the development of significant neurological consequences.
Head injuries are considered an emergency medical condition, which is why they are treated in medical services with special priority.
The first diagnostic action used in TBI has to do with determining the level of consciousness that the patient presents. The most widely used scale is the Glasgow Coma Scale (GCS), which offers us an initial index of severity. On the other hand, all the information related to the traumatic event is collected: how it occurred, where, initial symptoms, altered consciousness, etc..
In addition, some brain imaging techniques (magnetic resonance imaging or computed tomography) are used to locate the possible presence of brain lesions that require emergency medical intervention..
Normally, head injuries will cause different types of deficits: alterations in memory, attention, concentration, decision making, problem solving or even behavioral changes.
Complications and sequelae will fundamentally depend on the severity of the traumatic event. In mild type TBI, they may present minimal sequelae, however in the more serious ones, more severe ones may appear: chronic coma, physical disability, profound cognitive deficits, etc..
In any case, all those individuals who have just suffered a TBI should receive emergency medical attention..
The treatments used in the acute phase are aimed at controlling the immediate signs and symptoms of the traumatic event. It is essential to maintain vital signs and control possible bleeding and fractures.
In addition to the use of pharmacological measures, in some cases it may be necessary to address medical complications through surgical procedures to repair fractures, lacerations, bone inlays, development of clots, etc..
In the sub-acute phase, all therapeutic interventions will be oriented towards the recovery of the patient's level of consciousness and the affected cognitive and physical areas..
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