Head Injury: Concussion, Skull Fracture & Brain Bleeding

Head injuries range from a mild concussion that needs rest and time to a bleed inside the skull that needs surgery within hours. The injury that looks minor at the scene is not always the minor one, which is why the decision to get a CT scan is made on symptoms and risk factors rather than on how hard the blow seemed. Dr. Daggubati provides neurosurgical coverage for head trauma at hospitals across the region and follows patients through recovery.

Two groups deserve particular caution: older adults, in whom a fall from standing can cause a significant bleed, and anyone taking a blood thinner, in whom bleeding can begin hours after an injury that caused no immediate symptoms.

Treatment options

Without surgery

Most head injuries are managed without surgery: observation (at home with a responsible adult, or in hospital), rest followed by a gradual return to activity, headache management, reversal of blood thinners when there is a bleed, and repeat CT to confirm a small bleed is stable. Concussion recovery is supported by graded return to work, school and exercise.

Surgical options Dr. Daggubati offers

• Burr-hole drainage for chronic subdural hematoma
• Craniotomy to remove an acute subdural or epidural hematoma
• Decompressive craniectomy for severe brain swelling
• Repair of depressed skull fractures

Concussion

A concussion is a temporary disturbance of brain function without visible injury on a scan. Headache, fogginess, dizziness, sleep disturbance and irritability are common and usually settle over days to a few weeks. Rest for the first 24–48 hours, then a gradual return to mental and physical activity, is the modern approach; prolonged complete rest slows recovery. Symptoms lasting beyond a month deserve a specialist visit. A second concussion before the first has resolved carries higher risk, which is the basis of return-to-play rules in sport.

Bleeding inside the skull

Trauma can cause several kinds of bleeding, and the type determines the urgency:

• Epidural hematoma: bleeding between the skull and the outer membrane, often from a fractured temple. Classically a brief loss of consciousness, a lucid interval, then rapid deterioration. A surgical emergency with an excellent outcome when treated in time.
• Acute subdural hematoma: bleeding beneath the outer membrane, over the brain surface, often from a fall or collision. Larger collections that press on the brain need urgent craniotomy.
• Chronic subdural hematoma: a slow collection that develops over weeks after a minor injury, typically in older adults or people on blood thinners. Presents with headache, confusion, weakness or unsteadiness; treated with burr-hole drainage when symptomatic.
• Contusion (brain bruise): bleeding within the brain tissue itself. Usually watched with repeat scans; surgery only if swelling threatens.
• Traumatic subarachnoid hemorrhage: blood over the brain surface, usually managed without surgery.

Skull fractures

Most linear skull fractures heal on their own and need no treatment beyond observation. Fractures that are pushed inward (depressed), open, or over the sinuses or ear may need surgical elevation or repair to protect the brain and prevent infection or spinal fluid leak.

When surgery is needed

Surgery is recommended when a blood clot is large enough to shift the brain or raise pressure, when a patient’s condition is deteriorating, or when a fracture is depressed or open. The operation removes the clot and controls the bleeding; in severe swelling, a portion of the skull is temporarily left out and replaced weeks later once the swelling has settled. When surgery is not needed, the plan is close observation, control of blood pressure, reversal of blood thinners, and repeat imaging.

Expected recovery

• Concussion: most people recover within two to four weeks with a graded return to activity.
• Small bleed watched without surgery: a night or two of observation, repeat CT, then home; headache and fatigue for one to three weeks; blood thinners restarted on a schedule set with your cardiologist.
• Chronic subdural drainage: two to five days in hospital; most symptoms improve quickly; repeat scans over several weeks; recurrence in a minority, which is why blood thinners and embolization of the middle meningeal artery are discussed.
• Craniotomy for acute hematoma: recovery depends on how much the brain was injured before the clot was removed; it may involve intensive care and rehabilitation, with improvement continuing for months.

Every head-injury patient leaves with a written plan for warning signs, activity, and follow-up.

Common questions

Related conditions

• Spinal Fractures (Cervical & Thoracolumbar)
• Subdural Hematoma & Brain Hemorrhage