Post-Traumatic Head Injury: When to Seek Further Medical Evaluation

Post-head trauma

Doctor: Hello.
My father, who is 80 years old, suffered a head injury from a car accident two months ago.
He has been regularly visiting Mackay Memorial Hospital for follow-up.
Initially, there was a slight amount of intracranial hemorrhage, and the doctor said it could be observed as it would likely absorb on its own.
I would like to ask you: 1.
After two months, he has not experienced any headaches or dizziness.
Should we ask the doctor to perform a CT scan to check the status of the initial bleeding? 2.
Recently, I noticed a slight depression at the coronal suture where the parietal bone meets the right temporal bone (perhaps I hadn't paid attention before).
Is this a normal anatomical structure? I am concerned that it may be a consequence of the impact since he has had a head injury (he does not have any other symptoms of headaches or dizziness).
Should I take him back to see a neurosurgeon? (The doctor initially said it was unnecessary).
Since he is elderly, I worry that there might be oversight.
I apologize for asking such abrupt questions.
Thank you.

Xiao Xin, 40~49 year old female. Ask Date: 2019/03/26

Dr. Zhang Junwei reply Neurosurgery

1.
If there are no issues after two months, then there is likely nothing to worry about, and theoretically, a CT scan is not necessary.
2.
It could possibly be a normal anatomical structure.

Reply Date: 2019/03/26

More Info

When dealing with post-traumatic head injuries, especially in elderly patients, it is crucial to approach the situation with caution and thoroughness. Your father's case, having sustained a head injury two months ago with some initial bleeding, raises valid concerns about potential long-term effects and the need for further evaluation.

1. Follow-Up Imaging: Given that your father experienced a head injury with some bleeding, it is reasonable to consider follow-up imaging, such as a CT scan, even if he currently shows no symptoms like headaches or dizziness. While the initial assessment indicated that the bleeding was minor and would likely resolve on its own, changes in his condition or new symptoms could warrant a re-evaluation. The absence of symptoms does not entirely rule out the possibility of complications, such as delayed bleeding or other structural changes in the brain. Therefore, discussing the need for a follow-up CT scan with his physician is advisable, especially since he is elderly and may be at higher risk for complications.

2. Observation of Skull Changes: The observation of a slight depression at the coronal suture (where the frontal and parietal bones meet) and the right temporal bone is also concerning. While some variations in skull shape can be normal, especially in older adults, any new changes following a head injury should be evaluated. The depression could potentially indicate a previous fracture or other structural changes resulting from the trauma. It is essential to have a medical professional assess this to determine if it is a benign anatomical variation or a sign of a more serious issue related to the prior injury.

3. When to Seek Further Medical Evaluation: Given your father's age and the history of head trauma, it is prudent to err on the side of caution. If there are any new symptoms, such as changes in cognition, mood, or physical abilities, or if there is any noticeable change in the skull's appearance, a visit to a neurologist or a neurosurgeon would be warranted. Even in the absence of new symptoms, a follow-up appointment could provide peace of mind and ensure that any potential issues are monitored appropriately.

4. General Recommendations: Encourage your father to maintain regular follow-ups with his healthcare provider, especially if he has any underlying health conditions that could complicate recovery from head injuries. Keeping a close watch on any changes in his health status is essential. Additionally, ensuring that he has a supportive environment and is engaged in cognitive activities can help monitor his overall well-being.

In summary, while your father may currently be symptom-free, the history of head trauma and the recent changes in his skull structure merit further evaluation. It is always better to consult with a healthcare professional to ensure that no underlying issues are overlooked, particularly in elderly patients who may present differently than younger individuals.

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