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A Bump on the Head

Even a minor blow to the head can lead to serious trouble. A close relative of mine is an active, sharp guy in his 80's. He was hospitalized a few weeks ago with an infection and like many older folks, he wasn't aware of how weak he was and he tried to get out of the hospital bed and go to the bathroom and "whoops", he slipped and fell. Hospitals all have procedures in place to prevent falls and they monitor the number of patient falls and try very hard to get to zero. But, try as they do ...falls happen. OK, he got a bump on the forehead and a bruised shoulder but, fortunately no broken bones.

Fast forward 4 weeks. One weekend Allen was slurring his words and not walking well. You would think they would rush to the hospital to get things checked out, but they decided to wait and see if he was better the next day. This is a HUGE mistake. In a prior post I wrote about stroke and the need to seek immediate attention for any change in speech or one sided weakness. I am always surprised at how many patients do not seek medical help and instead wait to see if things will improve on their own. Ten out of ten times, symptoms like this do not improve.

Allen and his wife finally went to their doctor and he was immediately admitted to the hospital. A computed tomography (CT) scan revealed a large hematoma on his brain. The fall that occurred several weeks earlier had caused bleeding around the brain. Blood vessels can be damaged when the skull receives a blow, especially when the head hits a hard surface like the pavement. A hematoma is caused by a bleeding vessel and a subdural hematoma occurs when blood collects in the small space between the brain and the skull. The blood clot presses against the brain and the resulting pressure can severely damage the brain unless a neurosurgeon removes the blood. Fortunately, blood and blood clots are easy to detect with a CT scan.

After the subdural hematoma was diagnosed, Allen was rushed to surgery and the blood clot was removed. He has a large "s" shaped scar where the skull was removed (and replaced) and he is now home and doing great. His speech is back to normal and he continues to improve each day. Without surgery, Allen would not have made it. It is always nice when a story has a happy ending.

There are several take home messages here:
1. Any sudden change in speech or weakness or trouble walking needs immediate attention at the Emergency Department of the closest hospital.

2. Any fall that causes facial bruising or loss of consciousness needs evaluation.

3. Any time the head smacks against a hard surface, there is a chance of brain trauma because the brain can strike the inside of the skull.

4. Symptoms can show up weeks after trauma so don't ignore changes in personality or behavior, especially in older folks.


Good advice. I have some experience with this as I had a closed head injury back in the early 90's luckily I had no bleed but it left me with Post concussion syndrome. Symptoms were severe vertigo for months. Awful!
Anonymous said…
A head injury is potentially the most dangerous injury you can contract, yet a lot of people let them go unattended to, paving the way for the injury to become a lot worse, albeit gradually.

If you suffer a head injury then you should immediately contact a doctor, and if it wasn't your fault, then you can seek damages against the guilty party through a number of insurance groups.
rcpalmer said…
I had a fall two weeks ago this Friday on the back of my head and a bump about the size of an egg and then turned kinda mushy and now just sore

Guess i should go to the doctor (it happened when out of town, just got back to town this week) having headaches for the last 3 days
eddie said…
Hi i had swineflu last year and my lungs were failing i was put in prone position for 15 hours was very heavly sedated and a drug to paralise me i knew nothing of this, after 15 hours the nursing staff went to turn me to supine(on my front) but when they turned me over i had a massive haematoma over my eyebrow and the vent had cut my lips so bad, my parents asked the doctors & nurses what went wrong, all they said was" we turned your son to supine and it went seriosuly wrong" but would say what went wrong, how could this of happened apparently i coudnt move a finger so how did i get this huge haematoma i now have a massive scar because the hospital left the haematoma and never touched it
Anonymous said…
On Feb. 14th I fell and bumped my head on the sidewalk. Had a lump that filled the palm of my hand and was a half inch thick. Sfter putting ice on it for a couple of days the swelling went down some, but I still have a lump about two inches around. Didn't go to the Dr., but after reading this page I am wondering if I should still go. Gert
Julian said…
Whats so annoying is that these symptoms can lay dormant for days... so while people wait for the lump to go down they have a ticking time bomb inside their head.. not good.
Anonymous said…
like a week ago i was at my soccer game and i tried to head a ball sadly this girl did at the same time and we bonked heads, her head felt like steel and i got a knot on my head but now its gone. and i never felt better. but the girl didnt have a knot... weird
Anonymous said…
my head bumps so hard when i accidentally slipped while taking a bath and got lump on the upper left side of my head..this happened on 27th of October. its been a week over now and yet i didn't felt any symptoms for serious head injury. what i only felt is the numbness of lump.. i am aware that this could cause a serious brain damage such blood clotting. CT scan is pretty expensive so i could not ask for it yet. now, would it be ok if i'll just set aside for the main time and until i felt something wrong or wait for the symptoms to feel? what should i do?.

and another, does it safe if i dont felt any unusual feeling to my movements or any of the said symptoms? 'cause i am scared what could it bring damage to my brain..
Anonymous said…
I have a TBI already, which left me with seizures. I had a seizure last night and fell and hit my head on the tile floor very hard. Today I have a terrible headache & a large mushy lump at the base of my previous cranioplasty site. I am wondering if I should go the the e.r. for a C.T. or if the swelling will go subside?
Toni Brayer, MD said…
Dear Anon, Nov.20: Please do get it checked out. It sounds like you had a good deal of bleeding (creating the mushy bump) and that indicates a hard fall. The lump you feel is outside of the skull but a hard fall like that could create bleeding under the skull and that is where the subdural occurs. Please get checked and let me know how you do.
Anonymous said…
A friend sent me this link because she believes I am at risk. Your analysis of how a brain can be injured is comprehensible. Thank you.
Worried in NYC said…
Dear Doc,
I'm trying to help my teen but she doesn't belive me, I know she will belive you. Please help.
My daughter suffers from fainting episodes, extremely low blood pressure due to thickening of the mitrol valve
and a heart condition called neurally mediated syncope. She was diagnosed by a cardiologist
two years ago and us taking midrodrine. The problem is that she still has fainting episodes once a year.
The doctor has instructed her to drink water, get enough sleep, and take her medication.
Doctor has raised her medication 7.5 mg. Lat week she fainted again and hit her head hard.
Doctors in the ER warned about a heart valve might be needed in the future.
How can I convince my 18 year old teen to take her condition
seriously, to drink water get rest and take her medication as directed?
Toni Brayer, MD said…
Dear Worried,
I can read the concern and worry in your comment. By nature, teens feel indestructible and seldom listen to parents advice. Does she have a primary care doctor who could speak to her as an adult and get it out of your hands? You need an advocate who can be her guide. It may also be time to get her back with a cardiologist to assess her valve status too. Best of luck to your family.
marci said…
Dear Dr. Brayer,
Sunday I hit the lift door hatch on the back of the car getting groceries out. Had a small bump on the top of my head. Hurt like heck but not a big deal. Yesterday morning driving to work I had a sharp pain/tightness like a headband across my head and felt sort of squeezed in if that makes sense. No LOC but had weakness of right arm and tingling of lips. I work in a medical facility and had a friend nurse look at my eyes and pupils were very small but they were reactive. I did call my doctor but they could not see me until Wednesday. I am fine today but do you think it is possible to have had a blood clot from that little bump and developed some kind of ischemic event?
Toni Brayer, MD said…
A small bump from hitting a door is likely not hard enough to cause bleeding under the skull. Definitely keep your appointment and be mindful of any new symptoms. If the tingling persists it could be caused by a number of things so keep track of anything new so you can describe it accurately. Let's us know how you are. It doesn't sound like the head bump is the cause from your description.

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