A severe blow or jolt to the head can cause a skull fracture or a significant traumatic brain injury (TBI). The skull, a robust bony case, protects the delicate brain tissue, but an impact exceeding its structural limits can cause a break. Such an injury introduces the potential for internal bleeding, brain swelling, and infection, making rapid identification of symptoms important. Recognizing the signs of this trauma is paramount because immediate medical attention can significantly influence the outcome and limit long-term disability.
Immediate Physical Indicators of Injury
Direct trauma may result in visible physical signs near the impact site or where the fracture has allowed internal fluid or blood to escape. A depressed skull fracture, where a piece of bone is driven inward, can sometimes be felt as a deformity or dent in the head. This type of fracture carries a high risk of directly damaging the underlying brain tissue.
Blood or clear fluid draining from the ears or nose is a particularly concerning sign. This clear or yellowish discharge is often cerebrospinal fluid (CSF), the liquid that surrounds and cushions the brain and spinal cord. Its leakage indicates a tear in the dura mater, the tough membrane lining the skull, creating a pathway for infection like meningitis to enter the brain space.
Specialized bruising patterns can also signal a fracture at the base of the skull. “Raccoon eyes,” or periorbital ecchymosis, refers to dark bruising around both eyes that is not directly caused by a blow to the face. Similarly, Battle’s sign is bruising that appears behind the ear, over the mastoid process, and may take up to 24 to 48 hours to fully develop.
Acute Disturbances in Neurological Function
The most urgent signs of a serious head injury involve immediate changes to how the brain functions. Any period of unconsciousness, even if momentary, is a red flag that warrants immediate medical evaluation. A person may also exhibit severe confusion, disorientation, or an inability to recognize familiar people or places immediately following the trauma.
A severe and worsening headache often signals increasing pressure within the skull, potentially from internal bleeding or brain swelling. Another specific sign is anisocoria, where the pupils of the eyes are unequal in size. This can indicate pressure on the oculomotor nerve, which controls pupil function.
Other immediate neurological deficits include slurred speech, difficulty walking, or a sudden loss of coordination or balance. The onset of a seizure or convulsion after a head injury directly points to irritation of the brain’s electrical activity caused by the trauma.
Delayed and Persistent Warning Signs
Some of the most dangerous complications from a head injury can develop hours or even days after the initial event. Persistent or repeated episodes of nausea and vomiting can be a sign of rising intracranial pressure. This is often a result of swelling or a slow bleed that gradually increases pressure on the brainstem.
Changes in a person’s level of consciousness or behavior are also major delayed warning signs. Excessive drowsiness, difficulty waking the person up, or an inability to stay awake are signs that the brain is struggling. Changes in personality, such as new-onset irritability, agitation, or profound sadness, reflect an alteration in brain function.
Other symptoms that persist or worsen over the 24 to 48 hours following the injury include generalized weakness or numbness in the arms or legs. Persistent dizziness, vertigo, or a ringing in the ears may indicate injury to the inner ear structures or the cranial nerves. Monitoring the injured person for at least two days is important because delayed complications, such as a subdural hematoma, can be life-threatening.
Criteria for Emergency Medical Intervention
Immediate emergency medical services must be called if a person exhibits any signs of severe head trauma. The criteria for an immediate 911 response include any loss of consciousness, a seizure, or a severe headache that continues to worsen. Any drainage of clear fluid or blood from the ears or nose, or the presence of one pupil being noticeably larger than the other, requires urgent intervention.
While waiting for help to arrive, keep the person as still as possible and avoid moving their head or neck. Do not apply direct pressure to a wound if a skull fracture is suspected, as this could push fragments inward.