Persistent Dizziness After Head Injury: When to Seek Medical Imaging?

Head trauma has resulted in dizziness persisting for over a week?

Hello, doctor: My father (almost sixty years old) was struck on the left side of his head by a golf club about ten days ago.
He went to the emergency room that day, and the hospital said he could go home for observation, as his condition was at the borderline for hospitalization.
On the first day, he had some difficulty speaking and felt a sensation similar to a stroke.
By the third day, his condition was more stable, but he has been experiencing varying degrees of dizziness.
Now, ten days later, he particularly feels dizzy when he just wakes up, especially in the morning.
I am wondering if he needs a CT scan.
If a CT scan is necessary, which specialty should he see? Thank you.

A Ya, 30~39 year old female. Ask Date: 2010/11/18

Dr. Ding Xianwei reply Neurosurgery

Generally, the sequelae of head trauma include dizziness and headaches, which may persist for three to five months.
Therefore, it is possible that your father is currently experiencing the aftereffects of head trauma.
If he is only experiencing dizziness and has no other symptoms, and is fully conscious, a CT scan may not be immediately necessary.
However, in middle-aged and elderly men who have already experienced cerebral atrophy, there is a risk of chronic subdural hematoma, so it is advisable to monitor him for at least three months.
If any symptoms arise, further evaluation will be required, and surgery may be necessary if indicated.
Regarding the timing for a CT scan, it is generally performed when the physician's decision regarding further treatment varies.
For example, if a patient is comatose, it could be due to intracranial hemorrhage or simply an internal medical condition; in such cases, a CT scan is necessary to determine if surgery is needed for intracranial bleeding.
However, if a patient is conscious after head trauma, even if there is intracranial bleeding, the treatment approach remains intensive observation and symptom management.
Conducting a CT scan solely for reassurance may not benefit the patient and could lead to complacency if no intracranial bleeding is detected, ultimately delaying critical intervention.
Additionally, head trauma should be evaluated by a neurosurgeon, so your inquiry is appropriate, and outpatient visits should also be directed to neurosurgery.

Reply Date: 2010/11/18

More Info

After a head injury, especially one that involves a significant impact like being struck by a golf club, it is crucial to monitor for any persistent or worsening symptoms. Your father’s experience of dizziness, particularly upon waking, is concerning and warrants further evaluation.

In general, after a head injury, medical professionals often recommend a period of observation, typically 24 to 48 hours, to monitor for any delayed symptoms such as headaches, dizziness, confusion, or changes in consciousness. However, if symptoms persist beyond this initial observation period, as in your father's case, further investigation is warranted.

When to Seek Medical Imaging
1. Persistent Symptoms: If your father has been experiencing dizziness for ten days, especially if it is worsening or associated with other symptoms like difficulty speaking or a sensation of weakness (which he reported initially), it is advisable to seek further medical evaluation. Persistent dizziness can indicate underlying issues such as intracranial bleeding, concussion, or other neurological concerns.

2. Timing of Symptoms: The fact that his dizziness is particularly pronounced in the morning could suggest a few possibilities, including changes in intracranial pressure or fluid dynamics while lying down. This symptom pattern can be indicative of post-concussion syndrome or other complications that may require imaging to rule out serious conditions.

3. Neurological Assessment: Given your father's age and the nature of the injury, a thorough neurological assessment is essential. If he has experienced any changes in his cognitive function, balance, or coordination, these could be signs of more serious complications.

Recommended Imaging
If you decide to pursue imaging, a CT scan of the head is typically the first-line imaging modality used to assess for any acute intracranial issues such as bleeding or fractures. In this case, you would want to consult with a neurologist or an emergency medicine physician who can evaluate his symptoms and determine the necessity of a CT scan.

Conclusion
In summary, given the duration and nature of your father's symptoms, it is advisable to seek further medical evaluation. A CT scan may be warranted to rule out any serious complications from the head injury. It is always better to err on the side of caution, especially with head injuries, as timely intervention can be crucial in preventing further complications. Please ensure that he sees a healthcare provider who can assess his condition thoroughly and guide you on the next steps.

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