Head Injury: Concussion Through Intracerebral Hemorrhage

Head injury is a range of problems, from transient brain dysfunction to bleeding that compresses brain tissue and threatens herniation. A patient may look well while an intracranial hematoma is enlarging, so the trend in neurologic findings matters more than a single reassuring conversation. A concussion results from rapid acceleration–deceleration forces. Neurons develop metabolic dysfunction, producing transient functional impairment without structural injury. Headache, confusion, amnesia, dizziness, nausea, balance disturbance, and visual change are typical possibilities. Loss of consciousness is not required. In the clinical framework used here, a head-impact event with one or more of these symptoms and a Glasgow Coma Scale (GCS) score of 13–15 supports the diagnosis. A normal CT does not disprove concussion; there may be no structural lesion to see. It also does not make every patient with a normal scan safe to ignore. Worsening symptoms require reassessment. A cerebral contusion is different because brain tissue has been bruised and may contain focal bleeding. It commonly occurs at the site of impact or opposite the impact as the brain moves within the skull. Oedema and additional...