SKULL FRACTURE
How does a Skull Fracture occur ?
There are many different ways of injuring the head: road accident, fall and assault being the commonest. Whatever the cause, the injury moves the brain around within the skull, damaging nerves and blood vessels. This is called primary brain damage, or concussion. The amount of energy that reaches the brain determines the degree of concussion and ultimately the outcome of the injury. A head-on impact with a brick wall in a car may render the patient immediately unconscious, perhaps with fatal concussion. Conversely, goalkeepers being kicked in the head may be momentarily dazed and then recover to play a brilliant game, but not remember anything of it. Here the degree of concussion is slight and the sufferer recovers rapidly. Nothing can be done about primary damage to the brain (except preventing the original injury!). There are a number of secondary effects which can further affect an already damaged brain which can be prevented and sometimes reversed by prompt and skilled medical care. These include breathing problems, low blood pressure, clots within the head from continued bleeding, epilepsy, brain swelling and infection. Treatment involved for a Skull Fracture
MINOR HEAD INJURIES These need assessing with cleaning and stitching of any wounds. Patients can return home if someone responsible is available to recognise if a complication occurs. Complications include drowsiness, headache and vomiting: if they occur the patient should be brought back to hospital immediately. MINOR INJURIES WITH POTENTIALLY SERIOUS COMPLICATIONS The usual problem here is that a patient with a minor injury is slowly developing a blood clot in the head which is pressing on the brain. If the situation is recognized, the clot can be removed and a full recovery made. If not, the pressure on the brain can cause severe and even fatal damage. Most patients in these cases have a skull fracture. It is usual for all patients with a head injury to have a skull x-ray, and those with a fracture to be admitted to hospital for observation. If a clot is suspected the patient will have a computerized (CT) brain scan, which may require them to be moved to a neurosurgical unit. If the scan shows a clot it will be removed surgically. SEVERE HEAD INJURIES These usually occur as a result of a high speed injury (car crash, fall from a great height, rifle gunshot) and cause coma. Nothing can be done to help these victims and after careful assessment by experienced doctors the kindest thing for a patient and family is to withdraw treatment. In some cases, and with the aid of modern intensive care, the heart can be kept beating for several days after the accident. These patients may be brain dead . Sometimes severe head injuries can recover. The first step is to resuscitate patients as soon after the accident as possible, preferably starting at the accident site. The patient will then be stabilized at the nearest hospital. When all other life-threatening injuries have been dealt with, the patient can be moved to the nearest neurosurgical unit. There a CT brain scan will show if there are any blood clots in the head (removed if necessary) and the patient will then spend several days in an intensive care unit, usually on a breathing machine, with pressure in the head being carefully measured. If it rises to dangerous levels, treatment is given to try and reduce it. After intensive care, patients will usually need many weeks of intensive rehabilitation in hospital. Despite this, some are severely disabled. The others will have more minor disability and will be able to look after themselves and work. After treatment for a Skull Fracture
Even those with mild head injuries may take a surprisingly long time to recover fully. There may be many weeks of headache, dizziness, tiredness, loss of concentration and depression, a condition called post-concussion syndrome . Many patients do not seek help for this. Their work and home life suffers as many people around them do not understand why a patient who appears normal is not functioning normally. The condition always goes away, but may last for 6 months. Survivors of severe injury tend to fare worse. Some will never recover enough to leave hospital. Those who do may find a new disability that they need to cope with. A few will suffer from epilepsy, and even the ones who appear to have recovered totally may have a personality change, with loss of memory, reduced intellect and a short temper. Effects on the family of a Skull Fracture
People close to the patient have a big responsibility for immediately notifying the GP or hospital unit if a complication occurs following discharge. After severe injury, much tolerance and understanding is necessary by relatives and friends in dealing with the irritability, memory and personality problems. People close to the patient may benefit as much as the patient from involvement with a self-help group. |
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