A brain injury damages the cells of the brain and surrounding tissues, the bones of the skull, or the scalp. 

The injury may cause bleeding outside of the head, called head trauma, or inside the head, called a traumatic brain injury. Often, brain injuries happen from blunt force trauma, such as when the head contacts a hard or sharp object with a sudden blow or jolt. Common causes of head trauma and brain injuries include falls, sports injuries, car accidents, assaults, or explosions. 

Other health issues can also cause brain injuries. Often, these deprive the brain of oxygen, killing or damaging the brain cells. Acute health issues that can cause brain injuries include stroke, infection, tumors, toxins, and drug or alcohol overdose. 

Whether from a traumatic incident or health issue, brain damage may develop over the hours or days after a primary brain injury. These are secondary brain injuries.

One of the hallmarks of a head injury is that it causes trauma, or damage, to the head and brain. 

On the outside, a head injury may cause a bump, bruise, or cut. The bones of the skull can also break. 

Inside the brain, injuries are more complex. The brain can bleed, and the brain cells can get damaged. The pressure inside the skull can increase, and the fluid that cushions the brain can leak.

A solid hit to the head can cause a concussion, which causes short-term and even long-lasting effects. Many people will have an instant loss of awareness or alertness. A person may be "out" for a few minutes up to a few hours after a head trauma. 

If your skull bones don't break, you have what's called a closed brain injury. When this occurs, the brain moves rapidly inside the skull, which can cause bruising and tearing of brain tissue and blood vessels. 

Bleeding in the brain is often called either a hematoma or a hemorrhage. Bleeding can happen in the space around your brain or within your brain tissue. Blood pools and can put pressure on the brain tissue and lead to injury. Bleeding can cause headaches, vomiting, and temporary or permanent loss of function.

A hematoma is a bruise or blood clot in the brain. There are a few different types:

• Epidural: A blood clot underneath the skull on top of the covering around the brain, called the dura
• Subdural: A blood clot underneath the dura and outside the brain
• Intracerebral: Bleeding in the brain tissue, causing swelling

A diffuse axonal injury occurs when the shaking of the brain back and forth damages the brain cells. These don't bleed but can cause swelling and lead to permanent brain damage and even death.

Another major category of brain injury is when the brain doesn't get enough oxygen. This might happen during a stroke or carbon monoxide poisoning. 

• Anoxic brain injuries are when the brain is completely deprived of oxygen, causing brain cell death
• Hypoxic brain injury is when the brain gets some oxygen but not enough, and the brain cells gradually become impaired and die

When to see a doctor about a head injury

If someone has injured their head, go to the ER or call 9-1-1 if they have these symptoms:

• Behavioral changes
• Confusion, memory loss, or drowsiness
• Difficulty walking or speaking
• Fluid coming from the ears or nose
• Loss of consciousness
• Neck stiffness or severe headache
• One pupil is larger than the other
• Seizures or convulsions
• Vomiting

Many factors—including the size, severity, and location of the brain injury—influence how we treat a brain injury. Getting medical attention as soon as possible at a certified trauma center like Carilion will lead to the best health outcomes.

Rest

For minor head trauma, ice the area and have someone keep an eye on you for any odd behavior or symptoms. If you have a wound, use topical antibiotic ointment and adhesive bandage. If you have a mild headache, you can take over-the-counter pain medicines.

If you've had a concussion, you'll want to rest both your body and brain in the first few days. Avoid intense physical or mental activity. Minimize time looking at television, phone, and computer screens. Also avoid too much noise from loud music or voices.

Talk to your doctor about how and when to reintroduce activities. After the first few days you can slowly return to normal activities, if they don’t make you feel worse. Light screen use, reading or gentle exercise may be okay. New research has suggested that resting for too long can actually delay recovery.

Emergency care 

In the emergency department, the Carilion team will ensure you have oxygen, blood supply, and blood pressure after a major trauma. Our emergency room team will monitor blood flow to the brain and its oxygen supply and check your brain temperature and internal pressure.

You'll also get medicines from the emergency care team. These can include anticoagulants to prevent blood clots and diuretics to help reduce fluid buildup and reduce pressure in the brain.

Depending on your injuries, your doctor may have you stay at the hospital for observation.

Medicines

After your brain injury, you may need some medicines to treat symptoms. These may include: 

• Medicines to treat seizures
• Medicines to lower brain pressure
• Stimulants to increase alertness
• Antidepressants to treat depression
• Anti-anxiety medications for feelings of fear and nervousness

Procedures

When you're in the hospital after a severe head injury, we may need to monitor your brain pressure. We may place a device in your skull to accurately measure the pressure inside your head. The monitor may either be an external ventricular drain or an intracranial pressure monitor.

After you leave the hospital, other procedures can help you deal with symptoms of a brain injury:

• Botox injections for migraines or spasticity
• Occipital nerve blocks to treat chronic headaches
• Trigger point injections to relieve pain and relax muscles

Surgery 

After a brain injury or head trauma, you may need surgery to relieve pressure inside the skull or repair skull fractures. They'll also remove debris, dead brain tissue or blood clots. 

Some people with high brain pressure need a portion of the skull removed to relieve the brain pressure. This is a craniectomy. 

After your brain pressure is treated, we put the bone back, if we can. Sometimes we use an implant instead of your bone. The procedure to place the bone or implant is a cranioplasty.   

You may need additional surgeries to help treat post-traumatic epilepsy. Some people with traumatic brain injury will have seizures in the early stages or years after the injury. 

You may also need surgery to deal with fluid buildup in the brain (hydrocephalus), causing increased pressure and swelling.

Rehabilitation

After brain injury, you may have lingering symptoms. You may need rehabilitation to relearn basic skills such as walking, talking, and daily activities. Our physical medicine and rehabilitation doctors (called physiatrists), lead the neurorehabilitation program at Carilion.

Your expert rehab team may include neurologists, nurses, psychologists, and nutritionists, as well as physical, occupational, vocational, speech, and respiratory therapists.

Support

A brain injury can leave you feeling isolated. Lean on Carilion's Brain Injury Support Group for help. 

Carilion’s Brain Injury Center care team and the Keeley Healing Arts Program lead this supportive and engaging group. Our artists-in-residence use music and movement to encourage emotional expression, reduce stress, and promote well-being.

Whether you’re a traumatic brain injury or stroke survivor, caregiver, or family member, come connect, share and heal with others on a similar journey through the power of music and community support.