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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For A Head Injury

Hi Doc,
I was walking up a flight of stairs out of a low celing basement and caught the very back part of the top of my head on the overhang. There was some bleeding and a large knocking sound on my skull and instant pain but no stars or blackout. It's been several days and I feel a little off and don't feel like I'm seeing as well as I should but I've also been obsessing that I have a subdural hematoma. Thoughts?
Mon, 25 Jan 2016
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Neurologist, Surgical 's  Response
Hello. Thanks for asking from HCM.


I can understand your concern. It is good that you are conscious, oriented. But if you are feeling off and there is problem with vision after head injury, then you should consult doctor. He will evaluate you to know about degree of visual deterioration and any psychological dysfunction. If there will be any deficit, he might advise CT head to rule out fracture of skull and bleed in brain like subdural hematoma. Skull fracture is usually managed conservatively while brain bleed may require surgical evacuation.


Regarding your doubt about subdural hematoma, it can only be confirmed by CT head. Do not think about it much. Let doctor decide about its possibility. I can provide you some information about subdural hematoma. After going through it, you will be able to reach unto some conclusion and calm your anxiety

there are two types of subdural hematoma (SDH)
; Acute SDH - It occurs immediately after head injury. It is dangerous except small size. Large hematoma with brain swelling can cause immediate loss of consciousness, fits, coma, focal deficit and can lead to death rapidly. I don't think you are having dangerous acute SDH as you are conscious, oriented. Mild acute SDH can happen, but it is mostly managed conservatively.

: Chronic SDH - It occurs gradually over some time period after mild injury. It occurs mostly in old age (>60years), alcoholics, on blood thinner drugs (aspirin etc). Usual symptoms are progressive headache, forgetfulness, imbalance, focal deficit, fits. It may or may not need surgery depending upon severity of symptoms.

Hope it will help you. Thanks.

Take care.
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Neurologist, Surgical Dr. Ishu Bishnoi's  Response
Hello. Thanks for asking from HCM.


I can understand your concern. It is good that you did not have any symptom other than pain and weakness. For visual blurring, try to read letters from each eye (keeping other eye closed) from distance around 6 meter and also from near around 30 cm. You can also consult eye specialist for proper visual examination. You may be prescribed glasses for refractive error. Visual blurring due to head injury manifesting after few days is rare. Usually visual blurring after head injury manifests from the same day. It occurs due to optic nerve damage. Treatment is mostly medical, sometimes surgery may be needed to remove pressure from optic nerve.


We have to rule out dangerous head injury also by observing few signs of it
: vomiting
: bleed through nose/ear/throat
: fits
: onset of new focal deficit
: persistent non relieving headache, not decreasing even with painkillers
: loss of consciousness for more than 5 min or decreasing consciousness


If any of above signs, you should consult ER as soon as possible. The doctor might advise you CT scan of head to rule out bleed or fracture. Bleed may require surgical evacuation while fracture is usually managed conservatively.

If there is no above sign, it is mild head injury. For headache, you can follow few tips
: Apply icepacks at injury site
: You can take Diclofenac sodium after proper prescription
: Avoid pressure at injury site.


Hope it will help you. If still no relief, you can consult doctor.

Thanks. Take care.
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Suggest Treatment For A Head Injury

Hello. Thanks for asking from HCM. I can understand your concern. It is good that you are conscious, oriented. But if you are feeling off and there is problem with vision after head injury, then you should consult doctor. He will evaluate you to know about degree of visual deterioration and any psychological dysfunction. If there will be any deficit, he might advise CT head to rule out fracture of skull and bleed in brain like subdural hematoma. Skull fracture is usually managed conservatively while brain bleed may require surgical evacuation. Regarding your doubt about subdural hematoma, it can only be confirmed by CT head. Do not think about it much. Let doctor decide about its possibility. I can provide you some information about subdural hematoma. After going through it, you will be able to reach unto some conclusion and calm your anxiety there are two types of subdural hematoma (SDH) ; Acute SDH - It occurs immediately after head injury. It is dangerous except small size. Large hematoma with brain swelling can cause immediate loss of consciousness, fits, coma, focal deficit and can lead to death rapidly. I don t think you are having dangerous acute SDH as you are conscious, oriented. Mild acute SDH can happen, but it is mostly managed conservatively. : Chronic SDH - It occurs gradually over some time period after mild injury. It occurs mostly in old age ( 60years), alcoholics, on blood thinner drugs (aspirin etc). Usual symptoms are progressive headache, forgetfulness, imbalance, focal deficit, fits. It may or may not need surgery depending upon severity of symptoms. Hope it will help you. Thanks. Take care.