Head Injuries: Signs of Concussion and Bleeding Risks

Head trauma

Hello doctor, three days ago I fell off my bike and landed on my side.
At the time, it happened so suddenly that I don't remember the force of the impact on my head, but I did feel a bit dizzy.
After being taken to the emergency room, the dizziness subsided and my consciousness was clear.
The emergency doctor mentioned that since I did not lose consciousness, they would not perform a head examination.
However, my neck has been very stiff and painful to turn over the past few days.
I would like to know if it is possible to have a concussion or intracranial hemorrhage without losing consciousness, or if there could be chronic bleeding, especially since I only started noticing bruises on my body three days later.
Thank you, doctor.

Niming, 10~19 year old female. Ask Date: 2021/09/30

Dr. Zhao Shaoqing reply Neurosurgery

Delayed intracranial hemorrhage caused by head trauma is more likely to occur within the first three days, while the likelihood decreases after three days.
However, symptoms of a concussion may persist for up to a month.
Therefore, medication can be taken to manage symptoms, and rest can help improve the condition.
If any discomfort arises, a visit to the outpatient clinic for evaluation is recommended.

Reply Date: 2021/09/30

More Info

When it comes to head injuries, understanding the signs and symptoms of potential complications such as concussions and intracranial bleeding is crucial for ensuring proper care and recovery. Based on your description, it seems you experienced a fall while riding your bike, which can indeed lead to various types of head injuries, even if you did not lose consciousness at the time of the incident.

First, let's clarify what a concussion is. A concussion is a type of traumatic brain injury (TBI) that occurs when the brain is jolted or shaken inside the skull, often due to a blow to the head or a violent movement of the head and neck. Symptoms of a concussion can include headache, confusion, dizziness, nausea, balance problems, and difficulty concentrating. Importantly, loss of consciousness is not a requirement for a concussion to occur; many individuals may experience a concussion without ever losing consciousness.

In your case, the fact that you experienced some dizziness immediately after the fall could suggest a concussion, especially since you also mentioned neck stiffness and pain. Neck stiffness can sometimes accompany head injuries, as the muscles may tense up in response to trauma. However, it is also important to consider that neck pain could be a result of whiplash or other injuries related to the fall.

Regarding the risk of intracranial bleeding, it is essential to recognize that this can occur even without a loss of consciousness. Intracranial bleeding can manifest as a result of a direct impact or a sudden acceleration-deceleration injury. Symptoms of intracranial bleeding may include worsening headache, persistent vomiting, confusion, seizures, or changes in consciousness. The appearance of bruising on your body days after the incident could indicate that there was some degree of trauma, but it does not necessarily correlate with the presence of bleeding in the brain.

Given that you are experiencing neck pain and stiffness, it is advisable to seek further medical evaluation. While the emergency department may have deemed it unnecessary to conduct imaging studies at the time of your visit, your ongoing symptoms warrant a re-evaluation. A healthcare provider may recommend imaging studies such as a CT scan or MRI to rule out any serious injuries, including concussions or intracranial bleeding.

In terms of monitoring your symptoms, it is crucial to pay attention to any changes. If you experience any of the following, you should seek immediate medical attention:
- Severe or worsening headache
- Persistent dizziness or balance issues
- Nausea or vomiting
- Confusion or difficulty waking up
- Weakness or numbness in any part of your body
- Seizures
In summary, while the absence of loss of consciousness is a positive sign, it does not eliminate the possibility of a concussion or intracranial bleeding. Your symptoms of neck stiffness and pain, along with the history of trauma, suggest that you should follow up with a healthcare provider for a thorough evaluation. Early detection and management of any potential complications are vital for a full recovery.

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