Pathophysiology of head injury in seniors

  • Head injuries can be broadly classified into closed and open. Closed head injuries are more common in general.
  • A closed head injury is any injury in which the skull remains intact, such as, a bruise or a small bump. An open head injury is a severe injury in which the skull is broken, and the injury affects the brain, such as, a gunshot wound.
  • Severity and consequences of head injuries in senior citizens can vary from mild to severe and can also be fatal at times. Depending upon the type of injury and source of damage, most common head injuries can vary widely, such as, bruise, concussion, hemorrhage, hematoma formation, and traumatic brain injury.
  • When the injury is mild, the individual can suffer a mild skin bruise with some minimal swelling of the head at the site of impact that can resolve in due course of time.
  • When the injury is moderate to severe, the individual can suffer from concussion. In concussion, the injury can be severe enough to cause brain damage, due to the brain receiving a sudden jolt, hitting against hard surfaces, such as, head hitting against the floor during falls.
  • Brain damage during head injuries can result in bruising of brain. Depending on the intensity of the incident, individuals can also suffer skull fracture, rupture of blood vessels on the surface of brain & deep inside the brain, and severe bleeding. Rupture of blood vessels on the brain surface can result in accumulation of pool of blood on the brain, forming a hematoma.
  • Rupture of blood vessels inside the brain can result in bleeding into the protective coverings of brain (meninges). Meningeal bleeding can result in injuries such as, epidural hemorrhage, subdural hemorrhage, or subarachnoid hemorrhage. Bleeding into the brain tissue proper can result in intracerebral hemorrhage.
  • Bleeding and hematomas, both on the surface of brain and inside the brain tissue can clot, build immense pressure inside the head, and compress the brain, causing brain damage. Severe bleeding can also compromise blood supply to vital areas of brain and contribute to development of stroke.
  • The signs and symptoms of head injury can vary depending on the severity of the injury suffered. Also, some symptoms can appear during immediate 24 – 48 hours after injury and some symptoms can also appear in a few weeks after injury. The symptoms can progressively improve or worsen based on the impact of injury.

Precautions to be taken following a head injury

  • Following a head injury, caregivers must encourage the patients to report the following symptoms and observe the below mentioned lifestyle measures to prevent any future complications from the head injury suffered.
  • Head injury can result in severe inflammation at the site of injury and result in intense pain. Depending on the impact of injury suffered, any fractures sustained, bleeding involved, and deeper tissues affected, the intensity of pain can change over time. Report to your physician regarding any sudden or progressive worsening of pain.
  • Brain damage from head injury can result in increased risk for behavior changes during immediate time period post-injury. Sometimes, individuals can also present with these changes in a few weeks following the injury. Individuals can present with irritation, anxiety, sleep disturbance, decreasing alertness, confusion, and forgetfulness. Patients and caregivers must closely observe these behavioral changes after sustaining a head injury and report to the physician for further evaluation and follow-up. Observing compliance with general fall precautions, use of recommended assistive devices, and seeking for caregiver assistance can help prevent falls & accidents during these confused states. Observing compliance with intake of tranquilizers, if recommended, can help allay the irritation and anxiety. Practicing alternative relaxation techniques, such as, deep breathing, listening to soothing music, and yoga, can help with sleep promotion and relaxation.
  • Inflammation and swelling of the brain from head injury can increase the net weight of the brain. The heavier brain can exert more pressure on the vital centers located at the base of brain controlling blood pressure and respirations, thus compromising their function. This can lead to poorly controlled BP, shallow breathing, increased effort for breathing, and reduced endurance. In severe cases, this can also lead to respiratory arrest and death. Patients and caregivers must observe compliance with log maintenance of vital signs, such as, heart rate, blood pressure, and respiratory rate. Reporting to the physician regarding poorly controlled vital signs, increasing effort of breathing, and progressively reducing endurance can help early intervention and prevention of complications.
  • Brain damage from the injury can lead to disturbance in the nerve signals in the brain, which increases the risk for seizure development. The seizures can occur for a short time immediately after the injury and resolve later. But, in some cases, depending on the intensity of injury suffered, seizures can occur weeks later and continue to become permanent, thus necessitating medication intake for seizure control. Sometimes, the seizures can be severe and endanger life. Report to your physician at the first occurrence of any seizure episodes. Patients must be instructed regarding the possibility of seizures after head injury, their general presentation, and safety measures to be observed during a seizure episode. Observing precautionary seizure & accident prevention measures can be of additional help.
  • Impact to the brain from injury can result in concussion due to the brain receiving a sudden jolt, hitting against hard surfaces, such as, head hitting against the floor or wall during falls & accidents or some assault weapon during physical assault. Individuals can present with confusion, dizziness, and poor thinking abilities due to the injury suffered and pose problems with orientation to time, place, and person. Patients and caregivers must closely observe for and report worsening episodes of clouding of consciousness, any episodes of gradually evolving loss of consciousness, any progressive increase in frequency of altered consciousness states. Negligence on reporting these findings and thereby compromising on early interventions can lead to the patient ending up in comatose states, thus increasing risk for fatality.
  • Bleeding from the head injury suffered with consequent blood loss can result in hypotension. Individuals can present with fatigue, lightheadedness, blurred vision, which can contribute to the increasing confusion and fall risk. Individuals with history of predisposition to hypotension can be at higher risk to present with hypotension following a head injury. Patients and caregivers must closely observe for and report to the physician regarding any new or worsening signs and symptoms of hypotension. This can help early intervention, further evaluation of the patient complaints, and prevent development of complications. Observing precautions for hypotension management and fall prevention can help prevent further complications. Observing compliance with fluid intake and use of assistive devices, as recommended, can be additional supportive measures.
  • The swelling of brain tissue and bleeding inside the skull from head injury can exert pressure on the optic nerve helping for visual function and the nerves helping for the movement of eyes. This can lead to blurred spots in the visual field and in extreme cases can result in partial or complete vision loss. Difficulty with the eye movement in any particular direction can contribute to complications, such as, double vision. The problems with vision following a head injury could arise even after a few weeks, following the injury. They could include findings such as, progressive blurring of vision, narrowing field of vision, double vision, difficulty looking in any direction without head turning, and any partial/complete loss of vision. Report any new or deteriorating problems pertaining to vision to your physician for further assessment.
  • Head injuries involving traumatic damage to the brain can present with some serious consequences. Brain has many centers controlling many essential functions, such as, vision, speech, hearing, swallowing, appreciating sensations like touch & pain, initiating orders for muscle contraction & movements. Depending on the site of brain injury suffered, individuals can present with corresponding symptoms.
  • Damage to the area of brain controlling speech can result in speech difficulty and problems with expression. Patients and caregivers must be aware of the possibility for speech difficulty evolving over time after the head injury. Head injuries involving damage to the portions of brain controlling swallowing function can result in compromised act of swallow. This can result in increased risk for episodes of choking, aspiration of food particles into the lungs, and presentation with aspiration pneumonia. Report any issues of speech difficulty, difficulty swallowing solids and/or liquids, following a head injury, to your physician for early assessment and speech therapy interventions. Individuals with complaints of pre-existing speech problems and difficulty swallowing must report any worsening of these conditions following the head injury. Relying upon alternative means of communication, such as, writing and sign language can offer help.
  • Fear of choking and aspiration can motivate the individuals to reduce intake, thereby inviting serious risk for malnutrition, dehydration, and associated problems. Caregivers must keep a close watch on the intake of patients and encourage them for compliance with recommended fluid & calorie intake. Observing compliance with measures to prevent choking and aspiration can provide relief.
  • Damage to the brain controlling muscle contraction & movements can result in compromised gait and balance. This can lead to weakness, gait instability, and increased risk for falls & accidents. In severe cases of head injury, individuals can end up presenting with paralysis of various parts of the body. Following a head injury, report to your physician regarding any new onset or worsening weakness of any part of the body, poor/deteriorating balance, any falls suffered, and any presentation of paralysis involving any part of the body. Observing compliance with general fall prevention measures and use of recommended assistive devices can assist with safety of the individual. Avoiding risky behaviors and seeking caregiver assistance as needed can help promote safety.
  • Damage to the brain controlling appreciation of sensations can result in altered sensations and poor response to touch, temperature, pain, & pressure. Following a head injury, report to your physician regarding any new onset or worsening of appreciation of these sensations. Individuals with poor appreciation for these sensations can be at risk for burn injuries from heat and/or cold, and development of pressure ulcers. Observing compliance with precautions for heat and cold to avoid burn injuries can promote safety of the individual. Caregiver must encourage the patient for wearing appropriate gloves, socks, and footwear can also help. Individuals with coexisting complaint of diabetes must observe compliance with podiatrist visits and foot care recommendations made. Closely watching for compromised skin integrity on the dependent body parts, such as, hips, heels, and tailbone can be supportive. Timely change of position and use of recommended pressure-relieving devices, such as, special mattress, pads, or cushions can also help prevent development of pressure ulcers in such individuals.
  • Damage to the brain from head injury can affect portions of brain controlling bladder and bowel function. This can contribute to reduced bowel & bladder control with increased risk for bowel & bladder incontinence. Following a head injury, report to your physician regarding any new onset of or increasing frequency of bowel & bladder incontinence. Caregivers must be active in keeping a watch on the restroom trips being made and the frequency of accidents happening, to report to the physician regarding any sharp increase after head injury.