A closed head injury is trauma to the head that does not cause a break in the skull. Though the skull is intact, the brain and soft tissue can be damaged by violent movement of the brain in the skull. This can lead to bleeding and swelling inside the skull.
This type of injury is often minor but can lead to a traumatic brain injury which can cause a range of symptoms. Brain injury may be caused by the initial trauma or secondary injury. Secondary injury is caused by bleeding and swelling that is severe enough to increase the pressure on the brain. This pressure can lead to secondary damage and symptoms which may take hours to days to develop.
Closed head injuries are caused by a blow to the head or severe jerking motions of the head, neck or body. The most common traumas associated with head injuries include:
Factors that may increase your chance of a closed head injury include:
Symptoms can appear right away, or in the days and weeks following the injury. Symptoms may include:
A doctor should be consulted right away if any of the following is present:
If you have been evaluated for a closed head injury and your symptoms are getting worse, get medical help right away.
You will be asked about your symptoms and how the injury occurred. A doctor that specializes in the nervous system may be consulted.
Neurological tests will be completed. The tests will include observation of eye movements, limb movements, the ability to follow commands, and coherence of speech. The tests will help assess the impact on the brain tissue. The tests will also mark current level of symptoms to help measure any improvement or worsening.
A CT scan may be done if there are severe symptoms or certain risk factors but are not always needed.
Treatment will depend on the location and severity of the injury and specific symptoms. Both mental and physical rest will be needed to help any brain injury heal.
Minor injuries can temporarily affect how the brain works. It can affect brain tasks like memory, balance, concentration, judgement, and coordination. With simple rest, nearly all will have a full recovery.
Both mental and physical rest will be needed to allow the brain to heal. This includes limiting mental tasks like work or school. Returning to normal activities too soon can make symptoms worse and slow recovery. A gradual return to activities will also help minimize symptoms and continue recovery.
Return to a sport or recreational activity that was involved with the head injury may take longer. A second head injury before the brain has fully recovered can lead to more serious brain injury and damage.
Moderate or severe injuries can cause a lot of bleeding and swelling in the brain. The brain sits in an enclosed pocket made of protective tissue, a fluid called the CSF, and the skull. The bleeding or swelling of the brain or supporting tissue can suddenly increase the pressure in this pocket. The pressure can damage the brain and make current function difficult. With a closed head injury the skull remains intact which prevent a relief ffrom the pressure build up.
Immediate emergency care is required for moderate or severe head injuries to:
Medication may be used to help reduce swelling on the brain. The injury to the brain may stimulate seizures. Medication may help to manage or stop these seizures.
Surgery may be needed to help relieve this pressure. Options include:
Regular testing and monitoring will assess how the brain is recovering. It can take months or years for a complete recovery though symptoms should gradually improve during this time. The length of recovery will depend on a number of factors such as severity of injury, overall health, and age. Neurological and psychological testing will help monitor progress and guide rehabilitation.
Rehabilitation services such as physical therapy or occupational therapy may be needed during recovery for people with severe injuries. Therapy may help relearn movement, speech or memory processes, or adjust to challenges during recovery. Counseling may also be needed to manage frustration and anxiety during extended recoveries.
A closed head injury is often the result of an accident which can be difficult to prevent. To decrease the chance of severe injuries during an accident:
Falls are a common cause of head trauma, especially in older adults. To reduce the risk of falls:
American Academy of Neurology
Brain Injury Association of America
The Brain Injury Association of Canada
Ontario Brain Injury Association
Concussion and mild traumatic brain injury. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116529/Concussion-and-mild-traumatic-brain-injury. Updated October 9, 2017. Accessed November 10, 2017.
Mild traumatic brain injury/Concussions. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/concussion/feel_better.html. Updated January 22, 2016. Accessed November 10, 2017.
The management of minor closed head injury in children. Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research, American Academy of Family Physicians. Pediatrics. 1999;104:1407-1415.
10/5/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116529/Concussion-and-mild-traumatic-brain-injury: Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007. Pediatrics. 2010;126(2):352-357.
4/1/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116529/Concussion-and-mild-traumatic-brain-injury: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.
5/12/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116529/Concussion-and-mild-traumatic-brain-injury: Cantor J, Ashman T, et al. Evaluation of short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil. 2014;95(1):1-9.
Last reviewed November 2017 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.