A blow to the temple area carries a high potential for serious internal injury compared to other regions of the skull. This lateral aspect of the head, known as the temporal region, is located just behind the eye. Because of the delicate structures beneath, any impact to this site must be treated as a potentially life-threatening event. Even a seemingly minor strike can cause significant internal trauma due to the temple’s unique vulnerability.
Why the Temple Area is Especially Vulnerable
The heightened danger associated with a blow to the temple is due to the pterion, a specific anatomical junction. This region is where four different skull bones—the parietal, frontal, temporal, and sphenoid bones—meet and interlock. Unlike the thick, continuous bone found elsewhere, the pterion forms sutures that create a structural weakness.
The skull bone is significantly thinner at the pterion, making it the weakest point of the cranium. This thinness makes it susceptible to fracturing from impacts that might be absorbed elsewhere on the head. This thin bony layer lies directly over a major blood vessel supplying the dura mater, the tough outer membrane covering the brain.
Just beneath the pterion runs the anterior division of the Middle Meningeal Artery (MMA). This artery is fixed within a bony groove on the inner surface of the skull, making it highly susceptible to damage from a fracture. If the thin bone at the pterion fractures, the sharp edges can easily lacerate the underlying MMA.
Immediate Signs of Trauma
Following an impact to the temporal region, a person may experience immediate, observable symptoms. Localized pain and swelling are common, and a brief loss of consciousness can occur at the moment of injury. The trauma can cause a temporary disturbance in brain function, leading to a dazed feeling or confusion about the event.
Nausea and vomiting are frequently reported initial signs of head trauma. An immediate headache is also common, which may worsen over time. Even if these initial symptoms appear to resolve quickly, the possibility of a worsening internal injury remains a serious concern.
Signs such as dizziness, disorientation, or difficulty with balance suggest a concussion, or mild traumatic brain injury (TBI). Any significant blow to the temple warrants close observation and medical attention, even if symptoms seem mild. The initial presentation does not reliably indicate the full extent of the injury.
Life-Threatening Internal Injuries
The most feared consequence of a pterion fracture is the development of an Epidural Hematoma (EDH). This condition involves the rapid accumulation of blood between the inner skull surface and the dura mater. Since the Middle Meningeal Artery is an artery, the resulting bleeding is fast and under high pressure.
As arterial blood rapidly collects in the epidural space, it forms a mass that exerts pressure on the underlying brain tissue. Because the dura mater is firmly attached to the skull, the hematoma is often confined to a specific area, pressing inward on the brain. This increasing pressure, known as elevated intracranial pressure (ICP), can damage and displace the brain.
A classic feature of EDH is the “lucid interval.” The person may briefly lose consciousness upon impact, then wake up and appear relatively normal for a period lasting minutes or hours. This temporary improvement occurs while the hemorrhage is still expanding, before it exerts a life-threatening amount of pressure.
Following the lucid interval, the patient’s condition can deteriorate rapidly as the hematoma expands and the ICP rises significantly. Signs of this neurological decline include a worsening headache, repeated vomiting, confusion, and a rapid decrease in consciousness. If the pressure is not relieved surgically, the brain can shift and herniate, leading to permanent damage or death.
Essential First Aid and Medical Protocol
The most important action following a blow to the temple is to call for emergency medical help immediately, regardless of how minor the symptoms appear. Due to the high risk of delayed, life-threatening bleeding, every temple impact must be evaluated by a healthcare professional. Do not allow the person to move unnecessarily, and stabilize the head and neck to prevent potential secondary spinal injury.
A bystander should continuously monitor the victim for any changes. Signs of worsening internal pressure require immediate notification to emergency responders. These signs include:
- Increased drowsiness
- Difficulty speaking
- Unequal pupil size
- Changes in level of alertness
Applying a cold compress, wrapped in a cloth, to the injury site can help reduce external swelling and pain.
It is important to avoid giving the injured person pain relievers, such as aspirin or ibuprofen, which can thin the blood and potentially worsen internal bleeding. Furthermore, a person with a significant head injury should not be allowed to sleep until medically cleared, as monitoring for the lucid interval and subsequent decline is crucial. If the person becomes unresponsive, ensure their airway is open and be prepared to perform CPR if necessary.