closedhead

A closed-head injury is a type of traumatic brain injury resulting from an external mechanical force in which the skull remains intact. This contrasts with open or penetrating head injuries, where the skull is fractured or there is an entry wound. Closed-head injuries can involve focal damage to specific brain areas, diffuse damage from rapid movement of the brain within the skull, or a combination of both.

Mechanisms of injury commonly include blunt impact, rapid acceleration or deceleration, and rotational forces. These forces can cause contusions, hemorrhages, or diffuse axonal injury, where nerve fibers are stretched or torn. Mild closed-head injuries, such as concussions, may not show clear abnormalities on early imaging but can still disrupt brain function and lead to symptoms lasting days to weeks. More severe closed-head injuries carry a greater risk of intracranial bleeding, swelling, and long-term neurocognitive deficits.

Symptoms vary by severity and may include loss of consciousness, confusion, amnesia surrounding the event, headaches, dizziness, nausea, vomiting, sensory or motor changes, and cognitive or mood disturbances. Diagnosis typically begins with a clinical assessment using the Glasgow Coma Scale, followed by neuroimaging such as a CT scan to exclude acute hemorrhage or skull fracture. MRI may reveal injuries not seen on CT.

Management focuses on stabilizing the patient, monitoring for signs of intracranial pressure, and determining a safe plan for rest and gradual return to activities. Mild cases often recover with rest and close follow-up, while moderate to severe cases may require hospitalization, neurocritical care, and rehabilitation. Prevention includes helmet use, fall prevention, and safety measures to reduce head trauma risk.