Severe head injury - Symptoms, causes and treatment

Severe head injury is a condition when a person experiences an impact or hard pressure on the head which causingserious injury to the brain. If not treated quickly and appropriately, this condition can be fatal.

Severe head injuries can be caused by many things. Traffic accidents and experiencing physical violence are some of the events that often cause a person to experience this condition.

Based on the cause, head injuries can be divided into two types, namely:

  • Closed head injury

    This condition can occur due to a hard impact or jolt to the head which results in injury to brain tissue, even though the skull bones are still intact.

  • Open head injury or penetrating wound

    This condition can occur due to a blow that causes the skull to break or an object that penetrates (penetrates) the skull and brain, for example being shot in the head by a bullet.  

Causes of Severe Head Injury

A severe head injury can result from a blow, pressure, penetration, or a hard jolt to the head. Some of the common events that can lead to a severe head injury are:

  • Fall down
  • Injuries while exercising
  • Traffic accident
  • Physical abuse
  • Explosion of explosives or other materials

Serious head injuries can happen to anyone, but these conditions are generally more at risk for:

  • Man
  • Children, especially those less than 4 years old
  • Young adults, especially those aged 15–24
  • Seniors, aged 60 years and over

Symptoms of Severe Head Injury

Severe head injuries have a variety of symptoms that affect the sufferer physically and psychologically. Symptoms can appear immediately or several hours, even days after the head injury.

The following are some of the physical symptoms that can be experienced by sufferers of severe head injuries:

  • Dizzy
  • Severe headache
  • Stiff neck
  • Difficult to speak
  • Difficult to breathe
  • Difficulty moving some body parts
  • Bruising and swelling around the eyes or around the ears
  • Damage to the bones of the skull or face
  • Disturbances in the senses of the body, such as hearing loss or experiencing double vision
  • Constantly vomiting and spitting
  • Blood or clear fluid coming out of the ears or nose
  • Disorientation or not being able to recognize time, place, and people
  • Inability to move arms or legs
  • Changes in the size of the pupil of the eye
  • Seizures
  • Loss of consciousness
  • Amnesia

While the psychological symptoms that can be experienced by sufferers of severe head injuries include:

  • Being irritable
  • Feeling anxious or depressed
  • Having problems with memory and concentration

In children, symptoms may include:

  • Changes in diet or breastfeeding
  • Changes in sleep patterns
  • Fussy
  • gloomy
  • Loss of interest in favorite activities or toys
  • It's hard to stop crying
  • Losing focus
  • Looks sleepy
  • Seizures

Kshould you go to the doctor?

Take them to the doctor immediately if someone experiences a blow or injury to the head until symptoms appear that indicate a severe head injury, especially if the person experiences more serious symptoms, such as respiratory arrest.

A person who has the following conditions should be taken to a doctor immediately if they experience a blow or injury to the head:

  • Have you ever had brain surgery?
  • Taking alcohol or drugs before, especially drugs that can cause bleeding disorders, such as warfarin
  • Have you ever had a bleeding or blood clotting disorder?
  • Injuries occur due to a fairly hard impact, for example from being hit by a car or falling from a height of one meter
  • Injuries occur as a result of something intentional, such as being hit by someone else 

Diagnosis of Severe Head Injury

As a first step, the doctor will perform first aid to stabilize the patient's breathing, heart rate, and blood pressure. After the patient's condition is stable, the doctor will ask several questions regarding the symptoms and events that can be the cause of the head injury.

However, if the patient is unconscious, the doctor can request information from the person who brought the patient to the hospital. After that, the doctor will perform a thorough physical examination, including a neurological examination.

The doctor will use Glasgow Coma Scale (GCS) to assess the patient's consciousness and identify the severity of the head injury. The GCS value is determined based on three factors, namely:

  • Verbal response
  • Physical movement
  • Easy eye opening

The value of each of the factors above will be added up to produce a total score. Based on this total score, head injuries are classified into 3 levels of severity, namely:

  • Minor head injury: total score is on a scale of 13–15
  • Moderate head injury: total score is on a 9–12 scale
  • Severe head injury: total score is on a scale of 8–3

A score of 15 (highest score) indicates that the patient is fully conscious, can open his eyes spontaneously, speak and receive instructions. Meanwhile, a scale value of 3 (lowest score) indicates the patient is in a coma.

If needed, the doctor will also perform additional examinations, such as a CT scan or MRI, to get an image of the broken bone and detect possible bleeding in the brain, blood clots (hematoma), bruised brain tissue (contusions), or swelling of brain tissue.

Treatment of Severe Head Injury

Generally, people with severe head injuries undergo intensive care in the hospital to reduce the risk of complications. Some of the treatment methods that can be used to treat severe head injuries are:

Pefirst aid

In providing first aid to patients with severe head injuries, doctors will usually take the following actions:

  • Check breathing, heart rate and blood pressure
  • Perform cardiopulmonary resuscitation (CPR), when the patient experiences respiratory or cardiac arrest
  • Stabilize the neck and spine with a neck brace or spinal brace
  • Stop bleeding
  • Give intravenous fluids to prevent hypovolemic shock due to bleeding
  • Bandages cracked or broken bones
  • Prescribing pain relievers


After the patient's condition is stable, the doctor will recommend observation in the intensive room, where medical personnel will conduct periodic checks on:

  • Level of consciousness
  • The size of the pupil of the eye and its reaction to light
  • How well the patient moves the hands and feet
  • Breathing, heart rate, blood pressure, body temperature, and blood oxygen levels


The doctor will perform surgery if the patient with severe head injury has one or more of the following conditions:

  • Brain hemorrhage
  • Blood clots in the brain
  • Brain contusion (cerebral contusion)
  • skull fracture
  • Presence of foreign objects, such as broken glass or bullets

One of the surgical procedures that doctors can perform is a craniotomy, which is an operation by opening the skull bone. Stages of the craniotomy procedure include:

  • The doctor will make a hole in the skull for access to the brain.
  • The doctor will remove any blood clots that may have formed and repair the damaged blood vessels in the brain.
  • After the bleeding in the brain has stopped, the pieces of skull bone will be placed back in their original position and reattached with special nuts.

Treatment of skull fractures

Severe head injuries are sometimes accompanied by skull fractures. If the fracture experienced is severe, this condition is at risk of causing infection and increasing pressure on the brain. The doctor may perform the following actions to treat it:

  • Give antibiotics if there is an open fracture to prevent infection
  • Perform surgery to repair broken bones or remove bone fragments in the brain

However, in cases where the skull has only minor fractures, the above measures may not be necessary as the condition generally resolves on its own within a few months.  

The chances of recovery for patients with severe head injuries depend on the treatment provided. The sooner the condition is treated, the higher the chance of recovery.  

Complications of Severe Head Injury

A severe head injury can cause damage to the brain and lead to serious complications that can be fatal. Complications can occur temporarily or permanently. Some of the complications of a severe head injury that may occur are:


The risk of infection is higher if a severe head injury is accompanied by a skull fracture. This is because skull fractures can tear the thin protective covering of the brain. If this happens, bacteria can enter the brain and cause a brain infection.

Impaired consciousness

Some people with severe head injuries may experience disturbances of consciousness, such as coma and seizures vegetative state, namely the condition when the patient is conscious but unresponsive.

Symptom after concussion

A severe head injury can cause a concussion. Some patients may experience long-term symptoms from a concussion, such as:

  • Constant headaches
  • Sleep disturbance
  • Memory impairment
  • Poor concentration
  • Tinnitus

The above symptoms generally last for 3 months. Patients need to immediately consult a doctor if they feel these symptoms.

brain injury

A severe head injury can cause injury and brain damage. Brain injury or damage can cause a variety of disorders, including:

  • Epilepsy
  • Impaired balance and loss of body coordination
  • Impaired function of the senses of taste and smell
  • Difficulty thinking, processing information, and solving problems
  • Behavioral and emotional changes

Prevention of Severe Head Injury

Events that can lead to severe head injuries tend to occur suddenly and are therefore difficult to completely prevent. However, there are several things that can be done to reduce the risk of injury to the head. These include:

  • Use personal safety equipment when driving a motor vehicle and when exercising.
  • Avoid driving under the influence of alcohol or drugs that can affect alertness.
  • Make sure the house is free of objects that can make you fall, such as items scattered on the floor or slippery carpet.
  • Make sure the house is safe for children, for example by making sure windows or balconies are out of reach of children.