Post-Concussion Symptoms and Brain Hemorrhage Risks

Could you please provide more details about the issue related to cerebral hemorrhage?

Last Tuesday, I fell from a height and hit my head.
The height was about 180 to 200 cm, and I didn't land properly when I came down.
The area above the back of my head swelled up immediately after the fall.
I experienced dizziness for about a minute before I got up and went to the hospital that night for an emergency consultation.
The doctor first checked my consciousness and then advised me to monitor my condition over the next few days for any signs of dizziness or excessive sleepiness.
The doctor mentioned that if there was a brain hemorrhage, an X-ray wouldn't show it; only a CT scan could reveal any skull fractures or internal bleeding.
He said that if I didn't lose consciousness or feel faint, it likely meant there was no internal bleeding, and further scans would not be necessary unless there were symptoms.
He also noted that CT scans involve radiation, so it’s best not to have unnecessary scans if everything seems fine.
He advised me to rest and let me go home.
Recently, I’ve been feeling anxious, possibly due to psychological factors.
For the first five days, I sometimes felt a bit unsteady when getting up.
Today is the ninth day, and my condition has improved significantly.
I only experienced slight dizziness and nausea during the first three days, but I didn't vomit.
Occasionally, I feel a little dizzy when I first get up, but overall, I am feeling better.
1.
If there is no intracranial hemorrhage within two weeks, is it possible for it to suddenly occur later?
2.
How long should I wait to consider myself out of the danger zone—six months, a year—before concluding that there is no risk of brain hemorrhage?
Thank you.

Xiao Bai, 40~49 year old female. Ask Date: 2015/10/08

Dr. Ding Xianwei reply Neurosurgery

How long is the danger period after a head injury? The risk tolerance varies among individuals, so it can differ.
Generally, after three months, most people can accept the subsequent risks; however, it is impossible to say that intracranial hemorrhage will not occur afterward.
Regarding sequelae, about 5% of patients will continue to seek medical care due to the long-term effects of head injuries, suffering from these symptoms for the rest of their lives.
Additionally, it is important to clarify that sequelae and complications are not the same.

Reply Date: 2015/10/08

More Info

Hello! Thank you for sharing your experience and concerns regarding your recent head injury. It’s understandable to feel anxious after such an incident, especially given the potential risks associated with head trauma. Let’s address your questions and provide some additional context regarding post-concussion symptoms and the risks of brain hemorrhage.

1. Risk of Intracranial Hemorrhage: After a significant head injury, such as falling from a height of 180-200 cm, there is a risk of intracranial hemorrhage (bleeding within the skull). Your doctor’s assessment that you should monitor for symptoms like dizziness, excessive sleepiness, or changes in consciousness is standard practice. Typically, if you do not lose consciousness and your neurological examination is normal, the immediate risk of severe complications decreases. However, it is essential to remain vigilant for any new or worsening symptoms in the days following the injury.

2. Delayed Symptoms: It is possible for symptoms of intracranial hemorrhage to develop days or even weeks after the initial injury. This is often due to the gradual accumulation of blood or swelling in the brain. Therefore, while the risk may decrease significantly after the first few days, it is crucial to continue monitoring your condition. If you experience severe headaches, persistent vomiting, confusion, or any other concerning symptoms, you should seek medical attention immediately.

3. Safety Period: The timeline for when you can consider yourself "safe" from complications varies. Generally, the first 72 hours post-injury are critical, and many medical professionals suggest that if no significant symptoms arise during this period, the risk of serious complications diminishes. However, some experts recommend continuing to monitor for symptoms for up to two weeks, as some issues may not present immediately. After two weeks, if you have remained symptom-free, the likelihood of developing complications decreases significantly, but it is always wise to consult with a healthcare provider for personalized advice.

4. Post-Concussion Syndrome: It’s also important to be aware of post-concussion syndrome, which can occur after a concussion and may include symptoms such as headaches, dizziness, fatigue, and difficulty concentrating. These symptoms can last for weeks or even months after the injury. If you find that your symptoms persist or interfere with your daily life, it is advisable to follow up with a healthcare professional who specializes in concussion management.

5. Long-Term Monitoring: After a head injury, maintaining regular follow-ups with your healthcare provider is essential. They may recommend imaging studies, such as a CT scan or MRI, if there are any concerns about ongoing symptoms. Additionally, lifestyle modifications, such as ensuring adequate rest, managing stress, and avoiding activities that could lead to another head injury, are crucial during your recovery.

In summary, while the immediate risk of intracranial hemorrhage may decrease after the first few days, it is essential to remain vigilant for any new symptoms for at least two weeks. If you have any concerns or if your symptoms worsen, do not hesitate to seek medical attention. Your health and safety are paramount, and staying informed about your condition will help you navigate your recovery effectively. Take care, and I wish you a smooth and complete recovery!

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