Dizziness After Head Injury: When to Seek Further Evaluation

Slipping in the bathroom, head injury?

Hello Doctor,
I accidentally slipped and hit my head (upper right side of the occipital region) in the bathroom on November 28, 2023.
I went to the emergency room and received six stitches.
However, starting on December 6, 2023, I began to experience mild dizziness throughout the day, which I did not have before December 6.
On December 7, I went to a general surgery clinic to have the stitches removed, and I mentioned the dizziness to the doctor.
He said it was just mild dizziness and that no further examination was necessary, prescribing only anti-dizziness medication.
On December 9, I visited a neurosurgery clinic, and the doctor gave me the same advice as the general surgeon, telling me to just observe at home and that no further tests, including a CT scan, were needed.
Today, December 12, 2023, I am still experiencing mild dizziness throughout the day.
I am concerned whether this could be a concussion or intracranial hemorrhage.

A Long, 30~39 year old female. Ask Date: 2023/12/12

Dr. Jiang Junyi reply Neurology

Hello Mr.
A-Lung,
You mentioned, "On 2023/12/12, I have been feeling slightly dizzy all day.
I wonder if it could be a concussion or a brain hemorrhage?" Generally speaking, if there is no loss of consciousness, no anticoagulant use, or significant local hematoma, head trauma symptoms are usually mild.
However, you should consider the possibility of delayed bleeding and seek emergency care if you experience any of the following: (1) Deterioration of vision, seeing double (diplopia), or unequal pupil size.
(2) Clear fluid or blood leaking from the ears or nose.
(3) Confusion or abnormal behavior.
(4) Numbness or inability to move limbs.
(5) Localized involuntary movements or seizures.
Your symptoms may suggest a concussion.
The symptoms of post-concussion syndrome can be categorized into three main types:
1.
Physical symptoms: headache, fatigue, light sensitivity, neck pain, nausea, decreased balance, dizziness, etc.
2.
Emotional symptoms: anxiety, irritability, depression, personality changes, insomnia, etc.
3.
Cognitive symptoms: difficulty concentrating, memory problems, confusion, etc.
The symptoms that are often the hardest to recover from or last the longest are headaches, difficulty concentrating, and fatigue.
Patients are advised to ensure adequate sleep, reduce the intake of central nervous system stimulants (excessive tea and coffee), and limit alcohol and tobacco use.
If symptoms persist, it is recommended that you consult a neurosurgeon to discuss further evaluation and treatment.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Jun-Yi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2023/12/12

More Info

After experiencing a head injury, particularly one that involves a fall and subsequent symptoms like dizziness, it is crucial to understand the potential implications and when to seek further evaluation. Based on your description, you sustained a head injury on November 28, 2023, which required sutures. Following this, you began experiencing persistent dizziness starting December 6, 2023. Despite consultations with both general and neurosurgical specialists, you were advised to observe your symptoms without further imaging or intervention.

Dizziness after a head injury can be concerning and may indicate several underlying issues, including but not limited to concussion (also known as mild traumatic brain injury), intracranial hemorrhage, or other neurological complications. Here are some key points to consider regarding your situation:
1. Understanding Dizziness: Dizziness can manifest in various forms, including lightheadedness, a spinning sensation (vertigo), or a feeling of unsteadiness. After a head injury, these symptoms can arise from several causes, including vestibular dysfunction, post-concussion syndrome, or even psychological factors such as anxiety.

2. Concussion Symptoms: A concussion is a common result of head trauma and can lead to symptoms such as headache, confusion, dizziness, balance issues, and sometimes nausea. The symptoms can be subtle and may not always present immediately after the injury. It is important to monitor these symptoms closely, especially if they persist or worsen.

3. When to Seek Further Evaluation: While your doctors have advised observation, there are specific red flags that warrant immediate medical attention:
- Worsening headache or a new headache that is severe.

- Persistent or worsening dizziness that interferes with daily activities.

- Nausea or vomiting that is not resolving.

- Changes in vision, such as blurriness or double vision.

- Difficulty with balance or coordination.

- Confusion, difficulty concentrating, or changes in behavior.

If you experience any of these symptoms, it is advisable to seek further evaluation, potentially including a CT scan or MRI to rule out serious complications like intracranial bleeding.

4. Follow-Up Care: Given that your dizziness has persisted for several days, it may be beneficial to follow up with a neurologist or a specialist in sports medicine or concussion management. They can provide a more comprehensive evaluation and may recommend specific tests or therapies to address your symptoms.

5. Self-Care and Monitoring: In the meantime, ensure you are resting adequately and avoiding activities that could exacerbate your symptoms, such as strenuous exercise or activities requiring significant concentration. Keeping a symptom diary can also be helpful for your healthcare provider to understand the progression of your symptoms.

6. Potential for Recovery: Many individuals recover from dizziness and other symptoms following a head injury, but the timeline can vary significantly. Some may experience symptoms for weeks or even months, while others may recover more quickly. Engaging in cognitive rest and gradually returning to normal activities as tolerated can aid in recovery.

In conclusion, while your initial evaluations did not indicate the need for further imaging, the persistence of your dizziness is concerning. It is essential to advocate for your health and seek further evaluation if your symptoms do not improve or if new symptoms arise. Your health and well-being should always be the priority, and it is better to err on the side of caution when it comes to head injuries.

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