Post-Head Injury: Persistent Swelling and Worsening Dizziness Concerns

After a head injury, the swelling has not subsided and dizziness has worsened?

Hello Doctor: My mother (63 years old) slipped and fell in the bathroom a week ago, hitting the back left side of her head (no external injury but with noticeable swelling).
She immediately went to the hospital, where a CT scan was performed, and the doctor indicated that there were no significant abnormalities, prescribing medication (pain relievers and anti-nausea) for her to take home, with a follow-up appointment in three days at the neurosurgery department.
During the follow-up, the doctor only conducted an interview and did not re-examine the injury site, prescribing the same medication again and advising her to return home.
However, now, a week later (after taking the medication and applying ice for three days, followed by heat for three days), we have noticed that "the swollen area has slightly increased compared to a few days ago, and her dizziness has worsened." My mother has a long-standing history of dizziness (she has visited various hospitals and undergone numerous tests, but the cause remains undetermined), and she occasionally experiences exacerbations.
I would like to ask: 1.
Given this situation, does she need to return to a major hospital for further examination, or is it sufficient to just observe? 2.
If a medical examination is necessary, should she see a neurosurgeon again, or would it be more appropriate to consult another specialty? Thank you.

Māo bǎ, 30~39 year old female. Ask Date: 2022/07/16

Dr. Zhang Junwei reply Neurosurgery

It is recommended to return to the neurosurgery outpatient clinic for an examination.

Reply Date: 2022/07/16

More Info

It sounds like your mother is experiencing some concerning symptoms following her head injury. Given her situation, it is crucial to approach this matter with caution and seek appropriate medical advice.

1. Need for Further Medical Evaluation: Given that your mother has persistent swelling and worsening dizziness a week after her injury, it is advisable to return to the hospital for further evaluation. While the initial CT scan did not show any significant issues, the increase in swelling and the exacerbation of her dizziness could indicate complications that were not apparent during the first examination. It is essential to rule out any potential issues such as a hematoma (a localized collection of blood outside of blood vessels) or other forms of intracranial injury that might not have been detected initially.
2. Which Specialist to Consult: Since your mother has already seen a neurologist, it would be appropriate to continue with that specialist. Neurologists are trained to handle issues related to the brain and nervous system, including post-traumatic symptoms. However, if there are concerns about the structural integrity of the skull or if there are signs of increased intracranial pressure, it may also be beneficial to consult a neurosurgeon. They can provide a more in-depth assessment of any potential structural issues resulting from the injury.

In addition to these points, it is important to monitor her symptoms closely. If she experiences any new symptoms such as severe headaches, confusion, difficulty speaking, weakness in limbs, or changes in vision, these could be signs of a more serious condition requiring immediate medical attention.

Understanding the Symptoms: The swelling at the site of the injury can be a normal response to trauma, but if it is increasing, it may indicate that there is more going on than just a simple contusion. Dizziness can be multifactorial, especially if your mother has a history of dizziness. It could be related to the head injury, but it could also be exacerbated by her pre-existing conditions.
Management at Home: While waiting for the follow-up appointment, ensure that your mother is resting adequately and staying hydrated. Ice packs can help reduce swelling, but if the swelling is increasing, heat might not be advisable until a doctor evaluates her condition.
Conclusion: In summary, it is crucial to seek further medical evaluation given the worsening symptoms. A neurologist or neurosurgeon would be the appropriate specialists to consult. Keep a close watch on her symptoms and do not hesitate to seek immediate care if her condition deteriorates. It is always better to err on the side of caution when it comes to head injuries.

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