Skull Indentations: When to Seek Medical Attention for Head Injuries

Depressed skull or cranial depression?

Yesterday, my son's classmates were playing tag and ran through damaged playground equipment.
A hanging metal rod rebounded and struck my ten-year-old son's head.
Although there are no visible external injuries or swelling, there seems to be a 2-3 cm indentation when touched, and he complains of pain even with light contact.
Today, while doing homework, he mentioned that his head hurt a lot, but he hasn't complained since, although he still cries out in pain with light touches.
I'm concerned whether the impact from the metal rod may have caused a fracture in his skull.
Will he be able to run in the upcoming sports day in two days? Should we seek further medical evaluation? If so, which specialist should we consult?

Y, 40~49 year old female. Ask Date: 2018/12/06

Dr. Zhang Junwei reply Neurosurgery

Neurological surgery outpatient visit.

Reply Date: 2018/12/06

More Info

When it comes to head injuries, especially in children, it is crucial to take any signs of trauma seriously. In your case, your son experienced a blow to the head from a metal rod, which has resulted in a noticeable indentation and pain upon light touch. While there are no visible external injuries or swelling, the presence of a 2-3 cm indentation and complaints of pain are concerning and warrant immediate medical attention.

Understanding Skull Indentations
A skull indentation can indicate a variety of issues, including but not limited to:
1. Fractures: Even if there is no visible crack or break, the force of the impact can cause a fracture that may not be immediately apparent. Indentations can sometimes be a sign of a depressed skull fracture, where a portion of the skull is pushed inward.

2. Intracranial Injury: There is a risk of internal bleeding or swelling in the brain (such as a concussion or contusion) following a head injury. Symptoms may not always be immediate, and they can develop over time.

3. Pain and Sensitivity: The fact that your son experiences pain when the area is touched is a red flag. This sensitivity can indicate that the injury is more serious than it appears.

When to Seek Medical Attention
Given the symptoms you described, it is advisable to seek medical attention as soon as possible. Here are some guidelines on when to seek help:
- Immediate Symptoms: If your child experiences severe headaches, confusion, dizziness, vomiting, or any changes in consciousness, you should seek emergency care immediately.

- Persistent Pain: Since your son is experiencing pain with light touch and has had headaches, these symptoms should not be ignored.
- Changes in Behavior: If he shows any signs of lethargy, irritability, or difficulty concentrating, these could be signs of a more serious injury.

Recommended Medical Care
For your son's situation, you should take him to a pediatric emergency department or a pediatrician who specializes in head injuries. They will likely perform a physical examination and may recommend imaging studies, such as a CT scan, to assess for any fractures or internal injuries.

Activity Considerations
Regarding the upcoming sports event, it is crucial to prioritize your son's health over participation in activities. Engaging in physical activities, especially those that could lead to further head trauma, should be avoided until a healthcare professional has evaluated him and cleared him for such activities.

Conclusion
In summary, while it may seem that your son’s injury is minor, the symptoms you describe—particularly the indentation and pain—are significant enough to warrant a medical evaluation. Head injuries can have serious consequences, and it is always better to err on the side of caution. Please seek medical attention promptly to ensure your son receives the appropriate care and to rule out any serious injuries.

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