A severe head injury must always be treated in hospital to minimise the risk of complications.
The healthcare professionals treating you will prioritise any potentially life-threatening injuries.
For example, they may:
- check your airway is clear
- check your breathing and start cardiopulmonary resuscitation (CPR or mouth-to-mouth)
- stabilise your neck and spine – for example, by using a neck brace
- stop any severe bleeding
- provide pain relief if you're in a lot of pain
- splint any fractured or broken bones (strapping them into the correct position)
Once your condition is stable, you'll have a computerised tomography scan (CT) scan to help determine the severity of your injury.
Read more about diagnosing a severe head injury.
If you need to stay in hospital for observation, the healthcare professionals treating you will regularly check:
- your level of consciousness and how alert you are
- the size of your pupils and how well they react to light
- how well you can move your arms and legs
- your breathing, heart rate, blood pressure, temperature and the level of oxygen in your blood
These checks will be made every half an hour until it's clear you know who and where you are, you can speak and move as requested, and your eyes are open. After this, checks will be less frequent.
If your CT scan results show bleeding or swelling inside your skull, a small device called an intracranial pressure (ICP) monitor may be fitted. A thin wire will be inserted into the space between your skull and the brain, through a small hole drilled into the skull. The wire is attached to an electronic device that will alert hospital staff to any changes in the pressure inside your skull.
Cuts and grazes
Any external cuts or grazes to your head will be cleaned and treated to prevent further bleeding or infection. If there are foreign bodies in the wound, such as broken glass, they'll need to be removed.
Deep or large cuts may need to be closed with stitches until they heal. Local anaesthetic may be used to numb the area around the cut so you don't feel any pain.
Neurosurgery is any type of surgery used to treat nervous system problems (problems with the brain, spinal cord and nerves). In cases of severe head injury, neurosurgery is usually carried out on the brain.
Possible reasons for neurosurgery include:
- a haemorrhage – severe bleeding inside your head, such as a subarachnoid haemorrhage, which puts pressure on the brain and may result in brain injury and, in severe cases, death
- a haematoma – a blood clot inside your head, such as a subdural haematoma, which can also put pressure on the brain
- cerebral contusions – bruises on the brain, which can develop into blood clots
- skull fracture (see below)
These problems will be identified during tests and a CT scan. If surgery is needed, a neurosurgeon (an expert in brain and nervous system surgery) may come and speak to you or your family about it.
However, as the problems listed above can be serious and may require urgent treatment, there may not be time to discuss surgery before it's carried out. In such cases, your surgeon will take the time to discuss the details of the surgery with both you and your family after the operation.
A craniotomy is one of the main types of surgery used to treat severe head injuries.
During a craniotomy, a hole is made in the skull so that the surgeon can access your brain. The procedure will be carried out under general anaesthetic, so you'll be unconscious and unable to feel any pain or discomfort.
The surgeon will remove any blood clots that may have formed in your brain and repair any damaged blood vessels. Once any bleeding inside your brain has stopped, the removed piece of skull bone will be replaced and reattached using small metal screws.
Your skull may be fractured during a head injury. The CT scan will help determine the extent of the injury.
There are different types of skull fractures, including:
- simple (closed) fracture – where the skin hasn't broken and the surrounding tissue isn't damaged
- compound (open) fracture – where the skin and tissue is broken and the brain is exposed
- linear fracture – where the break in the bone looks like a straight line
- depressed fracture – where part of the skull is crushed inwards
- basal fracture – a fracture to the base of the skull
Open fractures are often serious because there's a higher risk of bacterial infection if the skin is broken. Depressed fractures can also be very serious because small pieces of bone can press inwards against the brain.
Treating skull fractures
Most skull fractures will heal by themselves, particularly if they're simple, linear fractures. The healing process can take many months, although any pain will usually disappear in around 5 to 10 days.
If you have an open fracture, antibiotics may be prescribed to prevent an infection developing.
If you have a severe or depressed fracture, surgery may be needed to help prevent brain damage. This will usually be carried out under general anaesthetic.
During surgery, any pieces of bone that have been pressed inwards can be removed and returned to their correct position. If necessary, metal wire or mesh may be used to reconnect the pieces of your skull.
Once the bone is back in place, it should heal naturally. Your surgeon will be able to explain the procedure you're having in more detail.
Depending on the seriousness of your operation, you may need to recover in an intensive care unit (ICU). This is a small, specialised ward where you'll be constantly monitored.
In an ICU, you may be placed on a ventilator, which is an artificial breathing machine that moves oxygen-enriched air in and out of your lungs.
Once you're well enough, you'll be moved to a high-dependency unit (HDU) or another ward and your condition will continue to be monitored until you're well enough to leave hospital.
Read more about recovering from a severe head injury.