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Dr Gérald Kierzek (Medical Director)
A more or less strong shock to the head can quickly cause us to panic. But how do you know if this is serious and how to react? Dr. Gérald Kierzek, emergency physician and medical director of Doctissimo, tells us what you need to know about this accident.
A concussion, or head trauma (we no longer use the term concussion, our expert tells us), is the consequence of an impact to the head, when the brain then hits the wall of the skull. It is not always serious, but in its most severe form it can cause lasting neurological problems over several months.
The injury is not rare, since there are around 155,000 head injuries per year in France. Despite everything, this state remains mysterious and quickly makes us panic.
Head trauma does not necessarily have visible signs
First thing to know, head trauma can be the consequence of multiple situations: a violent blow to the head, a fall, a car accident, a sporting collusion… “But unlike a sore, there may be no visible outward signs.” indicates Dr. Gérald Kierzek, emergency physician and medical director of Doctissimo.
The initial situation determines the urgency and seriousness for the doctor
The first thing to assess the severity of the shock is therefore based on what we call the kinetics of circumstance: “That is to say the violence of the shock in question. If you fell from the second floor, for example, even without signs, it is likely to be more serious than if you fell from your height and you will need to have a scan. Ditto, an impact in a car accident at more than 50 km/h will be more serious than a small impact while stopping.
Kinetics is therefore the first point that doctors evaluate.
There are symptoms specific to head trauma
The other element that allows the doctor to assess the severity is the appearance of significant symptoms. “These are headaches, dizziness, vision problems, nausea, confusion, loss of consciousness, loss of memory… Other neurological signs can indicate the severity: a flow of blood ear or paralysis of a limb will make us suspect a brain lesion.”
It is necessary to consult in case of seriousness and/or if the signs appear
How then should you react if a loved one, or their child, suddenly hits their head?
As seen previously, the severity must make you consult, or call for help: if the shock is violent, the fall is significant, if the person shows one or more neurological signs.
The attitude will be less urgent in the event of a milder shock without symptoms. “In the event of “weak” kinetics, relatives are advised to monitor the person or child for 24 hours. But if a neurological sign, such as loss of strength in a limb, projectile vomiting, severe drowsiness, occurs, it is also necessary to consult, even after the fall.
Be careful though: having a headache or feeling nauseated after a shock remains normal, “this is what we call the counter-coup”.
Treatment depends on severity and scans
Once in front of the doctor, the trauma is detected via a clinical examination (an interview) and a CT scan, or an MRI, which may have to be repeated within 72 hours in case of doubt. “The skull radio, on the other hand, is of no use” our expert tells us. The treatment will depend on this.
If the scan is normal, simple monitoring will be requested, with the possibility of another scan after 48 or 72 hours if there is any doubt about what is happening. In the event of a hematoma, an intervention can be scheduled. In the event of a serious hematoma, an artificial coma may also be considered to protect the brain. “But it will depend on the severity.”
There’s no need to worry about the future.
Once the trauma has been eliminated, or treated, there is no real reason to fear getting back into the car or getting back into sport, according to our expert. “On the other hand, what must be avoided is the repetition, the chronicity of micro-traumas which in the long run can impact memory, as in certain sports, football or rugby.