Concussion  |  contusion  |  subdural hematoma  |  epidural hematoma  |  skull fracture

What is a concussion? A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event. Your child may not remember events before or after the injury. The amount of time that the amnesia is present correlates with the severity of the injury. Your child may also feel dazed and lose vision or balance for a while after the injury. Cerebral concussion is the most common head injury seen in children. Rest and a slow return to normal activity is usually the treatment for a concussion.

Some children experience post-concussive syndrome days to weeks following the injury.  The child may have continued memory problems, dizziness, depression and behavior issues. Sometimes formal neuropsychological testing and an individualized education plan are needed to help school performance.

Second impact syndrome is acute brain swelling that occurs when a second or repeated concussion is sustained before complete recovery from a previous concussion. This can cause increased pressure and swelling inside the head, which may be difficult to control.  After several concussions, it takes less of a blow to the head to cause an injury and requires more time to recover. The risk of second impact syndrome should be considered in sports, such as boxing, football and hockey.

What is a contusion? A contusion is a bruise to the brain. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck. The majority of contusions occur in the frontal and temporal lobes of the brain.  When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in car accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a counter coup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues and blood vessels that may cause internal bleeding, bruising or swelling of the brain.

What is a subdural hematoma? A subdural hematoma is when bleeding occurs into the subdural space of the brain. It is caused from a rupture of small brain arteries and bridging veins. It can also be caused by a laceration of brain tissue. This can cause a shift or compression to the brain. The CT or MRI picture may show crescent shaped bleeding compressed on the brain and sometimes-surgical evacuation of the bleed is needed. The patient may have a period of loss of consciousness immediately after the head injury, which will recover.  The signs of a subdural hematoma include headache, sleepiness, confusion, and seizures.

What is an epidural hematoma? An epidural hematoma is when bleeding occurs between the skull and the tough outer layer of the brain called the dura mater.  This is caused by a laceration to the middle meningeal artery. The CT or MRI picture will show a lens-shaped bleeding compressed on the brain and usually surgical evacuation of the bleed is needed.  The patient may experience a period of a loss in consciousness, then recover, followed by a decreased level of consciousness. The prognosis is good when recognized and treated early.

What is a skull fracture?  A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:

Linear skull fractures - This type accounts for almost 70 percent of skull fractures. In a linear fracture, there is a break in the bone, but it does not move the bone. These children are usually observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. No interventions are usually necessary.

Depressed skull fractures - This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. Usually, this type of skull fracture requires surgical intervention to help correct the deformity.

Diastatic skull fractures - These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse with the growth of the child. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.

Basilar skull fracture - This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Children with this type of fracture frequently have bruises around their eyes "raccoon eyes" and a bruise behind their ear "battles sign". They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These children require closer observation in the hospital.