Falls are a frequent cause of head trauma, making the risk of Traumatic Brain Injury (TBI) a common public health concern. TBI occurs when an external force causes the brain to move rapidly within the skull, disrupting normal function. Falls remain the leading cause of TBI-related emergency department visits, hospitalizations, and deaths in the United States. Understanding the immediate and delayed signs of injury is paramount for knowing when a fall requires professional medical attention.
The Immediate Aftermath of Head Impact
When the head strikes a surface, the brain experiences acceleration and deceleration, resulting in a transient functional disturbance. This immediate impact often produces short-lived symptoms that do not necessarily indicate a life-threatening structural injury. The individual may feel momentarily dazed or stunned, which is a brief alteration in mental state.
A common physical sign is a transient headache or lightheadedness that passes quickly. Some people report a temporary visual disturbance described as “seeing stars,” resulting from mechanical forces affecting the occipital lobe. Any presence of confusion or disorientation means the individual must be monitored closely for several hours.
Distinguishing Levels of Traumatic Brain Injury
Traumatic brain injuries are classified by severity as mild, moderate, or severe, based on the individual’s level of consciousness and neurological functioning. Clinicians use the Glasgow Coma Scale (GCS), a standardized scoring system that assesses a patient’s motor, verbal, and eye-opening responses. A score of 13 to 15 on the GCS indicates a mild TBI, often diagnosed as a concussion.
A concussion is a functional injury, meaning the brain cells temporarily stop working correctly, but there is typically no visible structural damage on conventional imaging scans. Moderate TBI (GCS score of 9 to 12) or severe TBI (GCS 3 to 8) usually involves structural damage. These serious injuries can include skull fractures or intracranial hematomas, such as subdural or epidural bleeds. The existence of these lesions elevates the injury classification because they can cause pressure to build inside the skull.
Urgent Warning Signs and Medical Intervention
The primary danger after a fall is the delayed onset of a serious injury, where symptoms worsen over time, sometimes hours or days later. A persistent or progressively worsening headache that does not ease with medication signals increasing pressure within the skull. Repeated vomiting also indicates elevated intracranial pressure and warrants immediate medical evaluation.
Changes in consciousness are concerning red flags, including difficulty being roused from sleep or increasing confusion. Neurological deficits suggest a focal injury to the brain, such as new weakness or numbness on one side of the body, slurred speech, or an inability to walk normally. Additionally, clear fluid leaking from the nose or ears, or unequal pupils, signals a potential skull fracture or significant internal bleed. Seizures or convulsions following the fall require emergency medical services.
Prevention Strategies for High-Risk Groups
Proactive measures to prevent falls are important for high-risk populations, specifically older adults and young children. For the elderly, home safety modifications are necessary, as most falls happen within the living environment. Removing tripping hazards, such as unsecured throw rugs and clutter, and ensuring adequate lighting, particularly on staircases, can reduce risk.
Regular consultation with a healthcare provider is beneficial to review medications that may cause dizziness or drowsiness, which contribute to instability. Exercises focused on balance and lower-body strength, like Tai Chi, can help maintain the stability needed to prevent a fall. For infants and toddlers, prevention focuses on securing furniture to prevent tipping, installing safety gates, and ensuring play areas have soft, cushioned surfaces.