A blow to the head is always serious, but an impact to the temple area carries a specific risk profile due to its underlying anatomy. The temple is the region on the side of the head, located behind the eye and between the forehead and the ear. This temporal region is uniquely vulnerable compared to the rest of the skull, making assessment of potential injury severity crucial.
The Vulnerability of the Temple Area
The unique danger of a hit to the temple stems from an anatomical junction called the Pterion. The Pterion is the point where four different skull bones—the frontal, parietal, temporal, and sphenoid bones—meet. This junction is structurally much weaker than the solid bone plates that make up most of the skull. Because the Pterion is an interlocking seam of bones, it represents the thinnest part of the lateral skull. A moderate impact that might only bruise other areas of the head can cause a fracture at the Pterion. This fragility is compounded by the presence of the Middle Meningeal Artery (MMA), which runs directly under the Pterion on the inner surface of the skull. The MMA supplies blood to the dura mater. A fracture at the Pterion can lacerate this artery, leading to rapid bleeding inside the skull.
Immediate and Mild Symptoms
An impact to the temple often results in superficial and transient symptoms that do not necessarily indicate a severe brain injury. Localized pain at the site of impact is the most common immediate response. This is often accompanied by swelling or the rapid development of a visible hematoma, commonly known as a goose egg. Minor dizziness that quickly resolves and a transient, mild headache are also typical responses to a jarring impact. These symptoms suggest the injury is primarily confined to the scalp and outer layers of the skull. While these mild signs require monitoring, they usually respond well to basic home care such as rest and applying a cold compress.
Recognizing Severe Injury
The greatest concern following a blow to the temple is the possibility of an intracranial hemorrhage, such as an epidural hematoma, which can be life-threatening. An epidural hematoma occurs when blood pools rapidly between the skull and the dura mater, often due to a tear in the Middle Meningeal Artery. The resulting pressure quickly compresses the brain, leading to a decline in neurological function.
A significant warning sign is any loss of consciousness, even if momentary. Other neurological signs include a state of confusion, slurred speech, or difficulty recognizing people or places. Unequal pupil size, where one pupil is noticeably larger than the other, is an alarming sign of increased pressure on the brain that requires immediate attention.
Physical indicators of a serious problem include repeated vomiting, which signals rising intracranial pressure. A headache that becomes severe, unrelenting, or worsens over time, instead of improving, also suggests a serious injury. The leakage of clear fluid or blood from the nose or ears can indicate a skull base fracture and should be treated as an emergency.
A unique pattern associated with epidural hematoma is the “lucid interval.” This occurs when a person initially loses consciousness immediately after impact, then wakes up and appears normal and alert for a period of minutes or hours. This apparent recovery is misleading because arterial bleeding continues beneath the skull, causing the patient’s condition to rapidly deteriorate as the hematoma expands and exerts pressure on the brain.
Necessary Actions and Medical Assessment
Following any blow to the temple, immediate first aid involves applying a cold compress, such as an ice pack wrapped in a cloth, to the injury site for 15 to 20 minutes to reduce swelling. The injured person must stop all activity and rest.
Monitoring the person is crucial, and a responsible adult should remain with them for at least 24 hours to observe for delayed symptoms. Contrary to an old belief, it is generally acceptable for a person with a mild head injury to sleep, but they should be checked periodically to ensure their breathing and alertness remain normal. If severe symptoms are present, such as repeated vomiting, worsening headache, or any change in consciousness, emergency medical services should be called immediately.
Any symptom suggesting a neurological change, even if transient, warrants a trip to the emergency department for a thorough medical assessment. A doctor will perform a neurological examination and determine if imaging, such as a CT scan, is necessary to rule out internal bleeding or a skull fracture. Even if symptoms are mild, a follow-up consultation with a healthcare professional is important for a baseline assessment and to receive specific guidance on concussion protocol.