Closed Head Injuries in Adolescents

Adolescents have accidents as the leading cause of morbidity and mortality. Among the common injuries are closed head injuries or CHI. Many are associated with cognitive deficits after the injury is over with and maximum healing has taken place. In one study, 33 teens who sustained a closed head injury because of a motor vehicle accident or a pedestrian/motor vehicle accident were studied. Those with a closed head injury had cognitive memory deficits, intelligence deficits and problems with verbal fluency. It was felt that this might delay their reentry into the home environment, school or athletic activities.

Fortunately, most head injuries are mild and are unassociated with long term problems. Rarely, serious complications like bleeding around the brain or damage to brain tissue can occur that can lead to permanent cognitive deficits.

Closed head injuries in adolescents are caused by numerous different things. Falls are the most common causes of minor head trauma, followed by motor vehicle accidents, pedestrian accidents, bicycle accidents, child abuse and sports injuries. These are low force injuries that rarely result in permanent brain damage. High risk injuries that can easily cause permanent cognitive deficits are motor vehicle accidents, falls from large heights, being struck by an object at high speed and vigorous shaking of young babies in a condition called “shaken baby syndrome”.

The main injury symptoms include swelling of the scalp, loss of consciousness, which can last as long as several months or be as short as a few seconds, headache (occurs in about 20 percent), vomiting in 10 percent, seizures in less than 1 percent or a concussion. A concussion is a mild traumatic brain injury that can result in confusion, amnesia, headache, vomiting and dizziness.

It’s not always clear that an adolescent or child needs medical attention following a head injury. It is recommended by the American Academy of Pediatrics that anything that leads to more than just a light bump on the head should require a doctor’s evaluation. Any kid with recurrent vomiting, seizure, loss of consciousness, severe headache, behavioral changes, clumsiness, slurred speech, dizziness or is younger than six months of age should be seen in the emergency room. If there were great forces involved or a fall from more than five feet, there should be an emergency room visit. The same is true if the child is struck with an object at high speeds.

If a brain injury is suspected, the test of choice is the CT scan of the head without contrast. This shows areas of bleeding, bruising and swelling of the brain. A CT scan of the head is used whenever there is the concern of a serious head injury that needs further intervention and management. Doctors should definitely do a CT scan of the head in cases of prolonged loss of consciousness, persistent vomiting, severe memory loss, seizure, worsening headache, suspicion of abuse or behavioral changes. If there are signs that there might be a skull fracture or if the neurological exam is abnormal, CT scans need to be done.

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