Ten Questions Answered on Head Injury

  1. What are the common causes of head injury in our country?
    The commonest cause of head injury in our country is road traffic accident. Bad roads, insensitive driving, untrained drivers, drunken driving are all the factors. Contrary to other countries in India, pedestrians are at a higher risk in our country. Other causes are mob violence, fall from heights, industrial accidents, assaults and very rarely gunshot injuries.
  2. Are all head injuries serious in nature?
    No. Majority of head injuries are not serious. They need to be observed for 24 hours in hospital. Other injuries like chest injuries, abdominal injuries, facial injuries and long bone fractures need to be excluded. Majority of these patients can be discharged after 24 hours.
  3. Do all head injuries need to undergo surgery?
    No. Only severe head injuries may need surgical treatment. These are blood clots inside the brain (EDH, SDH, ICH), injuries to brain parenchyma (contusions), exposed compound depressed fractures etc.
  4. Will other organs be affected in head injured patients?
    Many other organs and parts may be affected in head injured victims. Neck injuries are commonly associated with head injuries. All head injured patients should have their necks assessed by x-rays and if needed by a CT scan. If there is any doubt one may have to do a MRI scan also. It is a dictum that all head injured victims should be considered having a neck injury until proved otherwise and all the necessary precautions need to be taken to reduce the secondary problems of a neck injury. The other common associated injury is to that of face. Facial injuries include soft tissue injuries and bony injuries. The major problem associated with facial injuries is a possible airway compromise. All steps should be taken to protect the airway in all head injured victims. In addition to this these people may have broken ribs, associated long bone fractures and injuries to abdominal organs. An ultra sound of the abdomen is mandatory in all head injured victims.
  5. How can one prognosticate a head injury?
    Majority of head injuries are minor head injuries needing 24 hours observation. The main indicator as for as prognosis concerned is level of sensorium at the time of admission and at the time of accident. If the victim is unconscious right from the time of injury, it is a very bad prognostic indicator. There is a coma score called Glasgow coma score which takes into consideration three things. Eye response, Verbal response and Limb movement response of the victim. A score is given from 3-15 depending on the three features. The best response is 15 and the worst response is 3. Head injured victims are classified into minor, moderate and severe head injury based on the coma score. The prognosis is good in case of minor head injury, guarded in moderate head injury and poor in severely head injured victims.
  6. What is the impact of technology on management of head injury?
    Technology has played a major role in the diagnosis and management of head injuries. The advent of CT scan has revolutionized the management of head injury management. In the pre CT era the only modality to investigate a head injured victim apart form x rays was a cerebral angiogram. It was an invasive investigation with lot of morbidity owing to the contrast agents used. The contrast agents used are toxic to kidney and other organs in the body. CT scan is non invasive but has the risk of radiation. Present day CT scans have reduced radiation risks. The time taken for completion of the study is also very also. Another important advantage is the study can be repeated to see if there are any fresh changes. It will aid the treating physician to take a preemptive action before the problem manifests clinically. The concept of intensive care unit with all noninvasive and invasive monitoring along with rapid developments in artificial ventilation has made head injury management very comfortable. Another technological advance is intra cranial pressure monitoring. A lead is kept inside the brain and the pressure in the brain is continuously monitored inside the brain. Any increase in the pressure beyond the prescribed limit can be tackled immediately before the problem adversely affects the victim. Another important development is the advances and innovations gained in the field of nutrition. Head injured victims need more calories and other nutritional supplements. Last but not the least developments in the fields of physiotherapy and rehabilitation have also had a major impact in the management of head injured victims.
  7. Has physiotherapy any role in the treatment of head injury?
    Physiotherapy and rehabilitation has a major role in the management of head injured victims. An unconscious patient needs physiotherapy right from the day of the accident. Initial physiotherapy consists of passive limb movements and chest physiotherapy (particularly in patients who are on ventilator). These patients needs frequent changing of position in their bed to prevent pressure sores. If limbs are not put in regular full range of motion every day wasting will set in and in the long rum will result in contractures. Adequate nutrition should also be a top priority in the management of head injured victims. Along with physical therapy occupational therapy should also be considered.
  8. What are the precautions that a head injured needs to take after recovery?
    The head injured patients need to take all the medications prescribed regularly. They should regularly consult the neurosurgeons, physiotherapists and occupational therapists. They should wear helmets if they are riding two wheelers. They should avoid drunken driving. They can become ambassadors and spread the awareness of safe driving to the society.
  9. What is the impact of head injury on the society ?
    The impact of head injury is very high on the society. Most of the head injured victims are between 15 and 40 years. They are in their prime. Majority of them are sole breadwinners for their families. The news that one of the family members was found unconscious on the road with a severe head injury is enough to shatter the family. Added to this the costs involved in treating and rehabilitating these severely injured individuals forces the concerned families to penury. Thus the family gets emotionally and financially drained. Most of these victims are completely dependent on others for their activities of daily life and these victims leave a heavy impact on the society.
  10. What are the steps to be taken by society in prevention of head injury?
    The society has a primary responsibility in prevention of head injury. Awareness should be created on safe driving. All the youngsters should be told about the importance of using helmet when they are driving two wheelers. They should be cautioned against speeding. The problems of drunken driving should be explained to them in detail. The print media and the electronic media should take more responsibility in explaining the importance of safe driving. As responsible citizens the onus is on all of us in preventing head injuries and making the society conscious of these facts.