Head & Spine Injuries

Common symptoms of head injuries include:

• Swelling around the eyes or ears or at the site of impact
• Bruising around the eyes or ears
• Unconsciousness for more than a few seconds
• Abnormal breathing
• Blood or clear fluid coming from the ears or nose
• Abnormal speech or vision
• Weakness or paralysis
• Headache
• Nausea
• Confusion and difficulty thinking

Common symptoms of spine injuries include:

• Pain
• Numbness and tingling
• Weakness or inability to move
• Loss of bowel and bladder control or inability to urinate
• Bruising around the spine
• Bone exposure

Head Injuries

There are many types of head injuries. These injuries can occur alone or in combination:

• Scalp injuries. The most frequent injuries to the scalp are abrasions, scrapes and lacerations. There are many blood vessels in the scalp, so even minor cuts bleed a lot, which can make these injuries frightening. Damage to the scalp can be more serious if the skull is exposed or if there are large tears, which may require stitches or surgical exploration. If your child's scalp injury is more than a small scrape, a visit to the emergency room can help prevent infection.

• Skull injuries. The skull protects the brain. The bones of the skull can break or crack. An open skull fracture occurs when the scalp is torn and the bone is exposed leading to a risk of infection. A closed skull fracture occurs when the scalp is intact and the bone is not exposed or contaminated. Types of skull fractures include:

  • Linear fractures. A linear fracture is a crack in the skull that does not separate into two pieces. If nothing has moved and the brain is not damaged, your child's doctor will recommend watchful waiting.
  • Depressed fractures. A depressed fracture involves a break and movement of the skull bones. One side of the skull will be pushed down farther than the other side. This type of injury may require surgery to realign the bone pieces and make sure there was not injury to the underlying brain.
  • Comminuted fractures. A comminuted fracture occurs when the bones of the skull break into multiple pieces. This injury may also require surgery.
  • Ping-pong fractures. A ping-pong fracture of the skull resembles a dented pingpong ball. This kind of injury is common in younger children and looks like a depression in the skull. Some of these require surgery, but other milder fractures often heal on their own.
  • Basilar skull fractures. A basilar skull fracture is rare. It is a break at the base of the skull, which includes the areas around the eyes, ears, nose and where the skull meets the spine. Signs of a basilar fracture include the appearance of raccoon eyes, bruising behind the ears and clear drainage from the nose or ears.
• Brain injuries. Sometimes trauma to the head also damages the brain. Types of brain injures include:
  • Concussion. The most common internal head injury is a concussion. It is usually mild but can be more serious. A doctor diagnoses concussion based on symptoms. Often, a computed tomography (CT) scan is normal. Patients may be confused, have headaches, lose consciousness and have difficulty balancing. This may be mild and resolve in minutes or hours, or it may be more serious and require a much longer recovery.
  • Contusion. A contusion is a bruising of the brain tissue. Contusions usually heal on their own unless there is brain swelling. When this happens, your child's doctor may need to take steps to reduce the pressure and swelling around the brain.
  • Epidural hematoma. An epidural hematoma is a type of hemorrhage. This is bleeding between the dura (protective covering around the brain) and the skull. Children with this injury can seem OK one minute and collapse the next. Small epidural hematomas can be watched, but larger ones require surgical removal.
  • Subdural hematoma. A subdural hematoma is bleeding under the dura and on the brain surface. These hematomas can be acute, subacute or chronic. New or acute subdurals have a jelly-like blood clot that may require surgical removal. As the blood clot ages (chronic subdural), it becomes thinner and runny like motor oil. Doctors treat it by making a small opening in the skull to drain the fluid. While some subdurals resolve on their own, surgical removal or surgical drainage may be required.
  • Subarachnoid hemorrhage. A subarachnoid hemorrhage is bleeding in the spaces of the brain where cerebrospinal fluid normally flows to cushion the brain. This kind of hemorrhage can increase pressure in the brain.
  • Intracerebral hemorrhage. An intracerebral hemorrhage happens when there is a blood clot in the brain tissue. This can cause an increase in brain pressure and may damage brain cells.
  • Intraventricular hemorrhage. An intraventricular hemorrhage is bleeding in the spaces within the brain that contain cerebrospinal fluid. This condition is common in premature babies. The bleeding can interrupt normal flow of the fluid in the brain (cerebrospinal fluid or CSF) and cause increased brain pressure. If this occurs, a tube may need to be placed into the brain to relieve the fluid pressure and drain the cerebrospinal fluid.
• Diffuse axonal injury. A diffuse axonal injury is a high-velocity impact injury that tears small pieces of the nerve cells in the brain cells. This injury leads to a coma and cannot be treated with surgery. Recovery times vary and often take weeks to months to judge.
• Penetrating trauma. A penetrating trauma occurs when a foreign object penetrates the skull and becomes lodged in the brain tissue. It is important not to remove these objects prior to seeing a doctor. Infection is common.

Spine Injuries

Falls and accidents involving bicycles and motor vehicles are the most common cause of spine injuries in young children. Motor vehicle accidents are also a common cause of spine injuries in adolescents.

Spine injuries can damage the bones of the spine (vertebrae) or the spinal cord. Some injuries involve fractures or dislocations of the bones around the spine. These may require surgery to stabilize the bones so they do not move and injure the spinal cord. If the bones are displaced, they may bruise or injure the spinal cord causing weakness, paralysis, changes in ability to feel or difficulty in controlling bowel and bladder function.

Diagnosis of Head & Spine Injuries

Neurosurgeons and emergency medicine specialists at Riley at IU Health perform the following exams and tests to diagnose head and spine injuries:

• Emergency room evaluation. If your child is involved in a traumatic accident, he or she will be evaluated for the signs of head and spine injuries, including any changes in movement, speech and comprehension.
• Magnetic resonance imaging (MRI). Doctors use advanced imaging to evaluate the extent of injury to the skull, brain, spinal column and spinal cord. MRI combines radio waves and a magnetic field to create computer images of the brain and spine.
• CT scan. This X-ray scan combines cross-sectional images to create detailed pictures of the nerve tissues in the spine and brain.

A patient's prognosis depends on the severity of the head or spine injury. The neurosurgery team at Riley at IU Health works to maintain and maximize functions controlled by the brain and spinal cord, including speech, movement and memory.