Head trauma

Head traumas are the most frequent single cause of death among persons 45 years of age or younger. The foremost aim of diagnostics and treatment is to avoid secondary traumas. Convalescence after less severe head injuries, such as brain concussion (commotio cerebri), usually passes without complications. Neurosurgical treatment is then not required. However, a CT scan is strongly recommended, alternatively observation in a hospital, even if the patient has experienced loss of consciousness for just a short period of time. This is done to minimize the risk of any complications, e.g. intercranial hemorrhages. The Norwegian Neurosurgical Association has its own guidelines for less severe head injuries.

Typical of severe head injuries is principally a longer and more profound loss of consciousness. The patient is assessed according to the Glasgow Coma Scale (GCS). Both immediately after the injury and throughout treatment, securing unobstructed air passages, adequate respiration and circulation is of the outmost importance. In any case of reduced consciousness, the patient is to be laid in Nato position.

The primary head injury, i.e. the damage done at the time of the traumatic experience, can for instance consist of contusions (crushed brain tissue), or diffuse axonal shearing (tearing of the nerve connections between different parts of the brain).

Secondary brain injuries occur when the brain doesn’t receive a sufficient amount of oxygen, either because of deficient respiration or reduced circulation. Moreover, hemorrhage from damaged blood vessels or crushed tissue, cranial fractures, hemorrhage from the brain’s membranes (epidural hematoma, subarachnoid hemorrhage, subdural hemorrhage), cerebral edema, hyperthermia, infection, or increased pressure on the brain, can all cause seconday brain injury. Patient in this category normally require intensive care in the neurosurgical department’s brain surveillance, and they must often undergo surgery.
 
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